Provider Demographics
NPI:1770835498
Name:ROSS, JENNIFER A (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10055 166TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3010
Mailing Address - Country:US
Mailing Address - Phone:425-466-8311
Mailing Address - Fax:425-556-9806
Practice Address - Street 1:10055 166TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3010
Practice Address - Country:US
Practice Address - Phone:425-466-8311
Practice Address - Fax:425-556-9806
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00142254163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse