Provider Demographics
NPI:1700608684
Name:ROSS, JEANETTE D (PROVIDER ENROLLMENT)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:D
Last Name:ROSS
Suffix:
Gender:F
Credentials:PROVIDER ENROLLMENT
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 1015
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-1015
Mailing Address - Country:US
Mailing Address - Phone:479-209-6471
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1015
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-1015
Practice Address - Country:US
Practice Address - Phone:479-209-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker