Provider Demographics
NPI:1548549660
Name:TENNANT, ROSS ANDREW III (RN)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:ANDREW
Last Name:TENNANT
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1244
Mailing Address - Country:US
Mailing Address - Phone:304-670-4906
Mailing Address - Fax:
Practice Address - Street 1:2140 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1244
Practice Address - Country:US
Practice Address - Phone:304-670-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV67041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program