Provider Demographics
NPI:1598801409
Name:ROSS, DONNA (RN, BSN, PHN II)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, BSN, PHN II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 SNOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-7284
Mailing Address - Country:US
Mailing Address - Phone:828-682-6118
Mailing Address - Fax:828-682-6262
Practice Address - Street 1:202 MEDICAL CAMPUS DR
Practice Address - Street 2:YCHD
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-9004
Practice Address - Country:US
Practice Address - Phone:828-682-6118
Practice Address - Fax:828-682-6262
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC159991163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC159991OtherNC STATE LICENSE NUMBER