Provider Demographics
NPI:1124333661
Name:ROSS, ELIZABETH AMALIA (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AMALIA
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:AMALIA
Other - Last Name:MARTINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1573 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:ME
Mailing Address - Zip Code:04965-3236
Mailing Address - Country:US
Mailing Address - Phone:207-368-5991
Mailing Address - Fax:207-368-5994
Practice Address - Street 1:1573 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:ME
Practice Address - Zip Code:04965-3236
Practice Address - Country:US
Practice Address - Phone:207-368-5991
Practice Address - Fax:207-368-5994
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP101050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily