Provider Demographics
NPI:1851637979
Name:ROSS, NOKEYA L (LPN)
Entity Type:Individual
Prefix:
First Name:NOKEYA
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 CATALPA DR
Mailing Address - Street 2:APT 2
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1720
Mailing Address - Country:US
Mailing Address - Phone:937-718-6070
Mailing Address - Fax:
Practice Address - Street 1:4278 CATALPA DR
Practice Address - Street 2:APT 2
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1720
Practice Address - Country:US
Practice Address - Phone:937-718-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN151675-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse