Provider Demographics
NPI:1447522537
Name:ROSS DEAR, MARCIE
Entity type:Individual
Prefix:MS
First Name:MARCIE
Middle Name:
Last Name:ROSS DEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7488A AHERN CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2218
Mailing Address - Country:US
Mailing Address - Phone:314-875-9146
Mailing Address - Fax:
Practice Address - Street 1:7488A AHERN CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-2218
Practice Address - Country:US
Practice Address - Phone:314-875-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant