Provider Demographics
NPI:1578302329
Name:ROSS, NADA JONELLE (FPMHNP-BC)
Entity type:Individual
Prefix:
First Name:NADA
Middle Name:JONELLE
Last Name:ROSS
Suffix:
Gender:F
Credentials:FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NY
Mailing Address - Zip Code:13667-0235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 235
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NY
Practice Address - Zip Code:13667-0235
Practice Address - Country:US
Practice Address - Phone:315-314-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406134363LP0808X
NY767511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse