1518576891 NPI number — MARCELLA ANN ROSS MSN, APRN, AGCNS-BC

Table of content: MARCELLA ANN ROSS MSN, APRN, AGCNS-BC (NPI 1518576891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518576891 NPI number — MARCELLA ANN ROSS MSN, APRN, AGCNS-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
MARCELLA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, AGCNS-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518576891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4825 W COUNTY ROAD 500 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH VERNON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47265-7344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-350-1256
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 E. 17TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-375-3229
Provider Business Practice Location Address Fax Number:
812-376-5937
Provider Enumeration Date:
07/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SC2300X , with the licence number:  28131551A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com