Provider Demographics
NPI:1902918923
Name:ROSS, LINDA (CFNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 RODEO RD
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4830
Mailing Address - Country:US
Mailing Address - Phone:505-417-8994
Mailing Address - Fax:
Practice Address - Street 1:4001 RODEO RD
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4830
Practice Address - Country:US
Practice Address - Phone:505-417-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM210P200X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM026408OtherBCBS
NMK5783Medicaid
NMQMYPRO0074146OtherMOLINA
10000294OtherLOVELACE HEALTHCARE
202014953OtherPRESBYTERIAN HEALTH PLAN
10000294OtherLOVELACE HEALTHCARE
NMS26172Medicare UPIN