Provider Demographics
NPI:1801375217
Name:ROSS, JENNIFER (BS, ASM, CPM, CM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:BS, ASM, CPM, CM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, ASM, CPM, CM
Mailing Address - Street 1:360 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4905
Mailing Address - Country:US
Mailing Address - Phone:713-213-4330
Mailing Address - Fax:
Practice Address - Street 1:360 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4905
Practice Address - Country:US
Practice Address - Phone:713-213-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1061176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife