Provider Demographics
NPI:1538417142
Name:ROSS, LAURA MIHAELA (FPMHNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MIHAELA
Last Name:ROSS
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14441 W MCDOWELL RD STE B102
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2519
Mailing Address - Country:US
Mailing Address - Phone:480-516-8037
Mailing Address - Fax:480-400-4383
Practice Address - Street 1:14441 W MCDOWELL RD STE B102
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2519
Practice Address - Country:US
Practice Address - Phone:480-516-8037
Practice Address - Fax:480-210-7543
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID663472084P0800X
AZAP46242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ729400Medicaid
AZZ191491Medicare PIN