Provider Demographics
NPI:1396834818
Name:ROSS, DARLENE J (RN, LMT)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:J
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:EAST PEMBROKE
Mailing Address - State:NY
Mailing Address - Zip Code:14056-0162
Mailing Address - Country:US
Mailing Address - Phone:716-560-1319
Mailing Address - Fax:585-762-9924
Practice Address - Street 1:8899 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7628
Practice Address - Country:US
Practice Address - Phone:716-560-1319
Practice Address - Fax:585-762-9924
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345911163W00000X
NY016978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist