Provider Demographics
NPI:1629682539
Name:ROSS, PAULA (RN, LLM, CPM, IBCLC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, LLM, CPM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2551
Mailing Address - Country:US
Mailing Address - Phone:501-436-8525
Mailing Address - Fax:501-492-6455
Practice Address - Street 1:305 E PINE ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2551
Practice Address - Country:US
Practice Address - Phone:501-436-8525
Practice Address - Fax:501-492-6455
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR053537163WL0100X
AR012020176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant