Provider Demographics
NPI:1417977091
Name:ROSS, CATHLEEN MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:MARIE
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CATHLEEN
Other - Middle Name:MARIE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3851 DELWOOD PL
Mailing Address - Street 2:PO BOX 231771
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4429
Mailing Address - Country:US
Mailing Address - Phone:907-441-0957
Mailing Address - Fax:907-562-7900
Practice Address - Street 1:2735 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1135
Practice Address - Country:US
Practice Address - Phone:907-762-8601
Practice Address - Fax:907-562-7901
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse