Provider Demographics
NPI:1457727653
Name:ACKER, ROSS (LPN, CNA)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:ACKER
Suffix:
Gender:M
Credentials:LPN, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4884 HIGHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1402
Mailing Address - Country:US
Mailing Address - Phone:608-669-6041
Mailing Address - Fax:
Practice Address - Street 1:4884 HIGHWOOD CIR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1402
Practice Address - Country:US
Practice Address - Phone:608-669-6041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319735164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse