Provider Demographics
NPI:1881687226
Name:RESS, ROBERTA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:
Last Name:RESS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W MARKET ST
Mailing Address - Street 2:STE 9
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2454
Mailing Address - Country:US
Mailing Address - Phone:256-233-3100
Mailing Address - Fax:256-233-2277
Practice Address - Street 1:1005 W MARKET ST
Practice Address - Street 2:STE 9
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2454
Practice Address - Country:US
Practice Address - Phone:256-233-3100
Practice Address - Fax:256-233-2277
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1068016367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL569100066Medicaid
AL51525361OtherBLUE CROSS BLUE SHIELD
AL051525361Medicare ID - Type Unspecified
AL569100066Medicaid