Provider Demographics
NPI:1871698241
Name:ROSS, CAROLEE A (NP)
Entity type:Individual
Prefix:
First Name:CAROLEE
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 GUZZI LN
Mailing Address - Street 2:STE. C
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5289
Mailing Address - Country:US
Mailing Address - Phone:209-533-0333
Mailing Address - Fax:
Practice Address - Street 1:690 GUZZI LN
Practice Address - Street 2:STE. C
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5289
Practice Address - Country:US
Practice Address - Phone:209-533-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10073363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health