Provider Demographics
NPI:1982845913
Name:ROSS, WYTINA SHAVONNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:WYTINA
Middle Name:SHAVONNE
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N DUKE ST
Mailing Address - Street 2:SUITE102
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1780
Mailing Address - Country:US
Mailing Address - Phone:919-479-9050
Mailing Address - Fax:919-479-9055
Practice Address - Street 1:3925 N DUKE ST
Practice Address - Street 2:SUITE102
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1780
Practice Address - Country:US
Practice Address - Phone:919-479-9050
Practice Address - Fax:919-479-9055
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-21
Last Update Date:2009-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty