Basic Information
Provider Information
NPI: 1235591314
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSS
FirstName: KATHRYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2845 BELL ST
Address2:  
City: ZANESVILLE
State: OH
PostalCode: 437011720
CountryCode: US
TelephoneNumber: 7404549766
FaxNumber: 7405886452
Practice Location
Address1: 1375 COMMERCE DR
Address2:  
City: NEW LEXINGTON
State: OH
PostalCode: 437649511
CountryCode: US
TelephoneNumber: 7403425154
FaxNumber: 7405886452
Other Information
ProviderEnumerationDate: 03/28/2016
LastUpdateDate: 03/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164W00000XPN056645 MEDSOHY Nursing Service ProvidersLicensed Practical Nurse 

No ID Information.


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