Provider Demographics
NPI:1821650979
Name:TICE, ROSS PATRICK (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:PATRICK
Last Name:TICE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 DEKALB AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3315
Mailing Address - Country:US
Mailing Address - Phone:347-952-6007
Mailing Address - Fax:
Practice Address - Street 1:1352 DEKALB AVE APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3315
Practice Address - Country:US
Practice Address - Phone:347-952-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293795251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care