Provider Demographics
NPI:1285867234
Name:ROSS, LAVERNE PATRICIA (RN)
Entity Type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:PATRICIA
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:DR
Other - First Name:LAVERNE
Other - Middle Name:PATRICIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4545 N 67TH AVE # U1096
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-1660
Mailing Address - Country:US
Mailing Address - Phone:623-846-1342
Mailing Address - Fax:
Practice Address - Street 1:4545 N 67TH AVE
Practice Address - Street 2:UNIT 1096
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-1660
Practice Address - Country:US
Practice Address - Phone:623-846-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN026555390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ791344OtherNPI