Provider Demographics
NPI:1194962266
Name:ROSS-MCCORMICK, CAROL (RN, NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ROSS-MCCORMICK
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7202 N MILLBROOK AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3341
Mailing Address - Country:US
Mailing Address - Phone:559-228-6600
Mailing Address - Fax:559-226-3709
Practice Address - Street 1:568 E HERNDON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2989
Practice Address - Country:US
Practice Address - Phone:559-228-6600
Practice Address - Fax:559-226-3709
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA483915163WN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No163WN0300XNursing Service ProvidersRegistered NurseNephrology