Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 100324 | MO |
NPI | 1013036979 |
---|---|
Provider Name | Sarah Ross |
First Address | Cape Girardeau, MO 63703-4927 |
Second Address | Cape Girardeau, MO 63703-4927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 02/10/2014 |