Provider Demographics
NPI:1790239432
Name:ROSS, CORNELIA NAN (RN)
Entity Type:Individual
Prefix:MISS
First Name:CORNELIA
Middle Name:NAN
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2632
Mailing Address - Country:US
Mailing Address - Phone:843-664-8160
Mailing Address - Fax:843-679-6752
Practice Address - Street 1:1100 N IRBY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2632
Practice Address - Country:US
Practice Address - Phone:843-664-8160
Practice Address - Fax:843-679-6752
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93039163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool