Provider Demographics
NPI:1700293859
Name:ROSS, COLLEEN M (NP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-1305
Mailing Address - Country:US
Mailing Address - Phone:712-623-7000
Mailing Address - Fax:
Practice Address - Street 1:2301 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1305
Practice Address - Country:US
Practice Address - Phone:712-623-7226
Practice Address - Fax:712-623-6472
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA097877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily