Provider Demographics
NPI:1437570769
Name:ROSS, ROYCE W (CSW)
Entity Type:Individual
Prefix:
First Name:ROYCE
Middle Name:W
Last Name:ROSS
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 Q ST
Mailing Address - Street 2:APT # 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3643
Mailing Address - Country:US
Mailing Address - Phone:402-474-2121
Mailing Address - Fax:402-477-9752
Practice Address - Street 1:2039 Q ST
Practice Address - Street 2:APT 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3643
Practice Address - Country:US
Practice Address - Phone:402-474-2121
Practice Address - Fax:402-477-9752
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE00172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker