Provider Demographics
NPI:1790755114
Name:ROSS, DONNA M (CNS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14519 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4316
Mailing Address - Country:US
Mailing Address - Phone:216-529-8500
Mailing Address - Fax:216-528-8505
Practice Address - Street 1:14519 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4316
Practice Address - Country:US
Practice Address - Phone:216-529-8500
Practice Address - Fax:216-528-8505
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-08553364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCPT.020491OtherCERTIFICATE TO PRESCRIBE