Provider Demographics
NPI:1215694476
Name:ROSS, MICHELE YOUNG (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:YOUNG
Last Name:ROSS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:WEST SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:16061-1703
Mailing Address - Country:US
Mailing Address - Phone:724-290-8481
Mailing Address - Fax:
Practice Address - Street 1:213 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:WEST SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:16061-1703
Practice Address - Country:US
Practice Address - Phone:724-290-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024715363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner