Provider Demographics
NPI:1740933480
Name:KEAN, ROSS THOMAS (RN)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:THOMAS
Last Name:KEAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 DELAWARE AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3561
Mailing Address - Country:US
Mailing Address - Phone:585-645-2042
Mailing Address - Fax:
Practice Address - Street 1:2035 DELAWARE AVE APT 3E
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3561
Practice Address - Country:US
Practice Address - Phone:585-645-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY819342163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse