Provider Demographics
NPI:1871598896
Name:ROSS, ELIZABETH A (RN, MSN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
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Mailing Address - Street 1:77 W MARCH LN STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5724
Mailing Address - Country:US
Mailing Address - Phone:209-477-5552
Mailing Address - Fax:209-477-5553
Practice Address - Street 1:77 W MARCH LN STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5724
Practice Address - Country:US
Practice Address - Phone:209-477-5552
Practice Address - Fax:209-477-5553
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA333379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD307ZMedicare PIN
CAS63894Medicare UPIN