Provider Demographics
NPI:1932508330
Name:ROSS, LAUREN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 2ND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-2084
Mailing Address - Country:US
Mailing Address - Phone:313-748-4200
Mailing Address - Fax:
Practice Address - Street 1:7430 2ND AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2739
Practice Address - Country:US
Practice Address - Phone:313-748-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704261663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily