Provider Demographics
NPI:1457304065
Name:ROSS, CECILIA DUARTE (PA-C)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:DUARTE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9016
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:8301 OLD COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3804
Practice Address - Country:US
Practice Address - Phone:703-442-0301
Practice Address - Fax:703-442-0337
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant