Provider Demographics
NPI:1881837953
Name:ROSS, JANA MICHELE (IDMT)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:MICHELE
Last Name:ROSS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 LOUISIANA DR
Mailing Address - Street 2:7 TH AMDS/SGGF
Mailing Address - City:DYESS
Mailing Address - State:TX
Mailing Address - Zip Code:79607
Mailing Address - Country:US
Mailing Address - Phone:325-696-5490
Mailing Address - Fax:
Practice Address - Street 1:697 LOUISIANA DR
Practice Address - Street 2:7 TH AMDS/SGGF
Practice Address - City:DYESS
Practice Address - State:TX
Practice Address - Zip Code:79607
Practice Address - Country:US
Practice Address - Phone:325-696-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians