Provider Demographics
NPI:1275763260
Name:ROSS, RACHAEL ANNE
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANNE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5887
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71307-5887
Mailing Address - Country:US
Mailing Address - Phone:318-508-1653
Mailing Address - Fax:
Practice Address - Street 1:1444 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3432
Practice Address - Country:US
Practice Address - Phone:318-442-5399
Practice Address - Fax:318-442-1586
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097882-AP05738367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered