Provider Demographics
NPI:1639205057
Name:ROSS, MELISSA JANE
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JANE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4997 BASSETT RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:OH
Mailing Address - Zip Code:44201-9378
Mailing Address - Country:US
Mailing Address - Phone:330-947-3635
Mailing Address - Fax:
Practice Address - Street 1:1612 WOODLAND CT
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-1147
Practice Address - Country:US
Practice Address - Phone:330-963-7985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6700636376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker