Provider Demographics
NPI:1366820995
Name:ROSS, CORTNEA DOUGLAS
Entity Type:Individual
Prefix:MRS
First Name:CORTNEA
Middle Name:DOUGLAS
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 1:272 BELLA SERA LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4854
Mailing Address - Country:US
Mailing Address - Phone:504-206-1510
Mailing Address - Fax:
Practice Address - Street 1:272 BELLA SERA LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4854
Practice Address - Country:US
Practice Address - Phone:504-206-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)