Provider Demographics
NPI:1679361380
Name:ROSS, AIMEE (RN)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2551 GREENWOOD RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3984
Mailing Address - Country:US
Mailing Address - Phone:318-212-8627
Mailing Address - Fax:318-212-8632
Practice Address - Street 1:2551 GREENWOOD RD STE 130
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3984
Practice Address - Country:US
Practice Address - Phone:318-212-8627
Practice Address - Fax:318-212-8632
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN089862163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator