Provider Demographics
NPI:1366607525
Name:ROSS, HEATHER MAURA (ANP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAURA
Last Name:ROSS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 E CHERYL DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1100
Mailing Address - Country:US
Mailing Address - Phone:480-993-6081
Mailing Address - Fax:775-370-7971
Practice Address - Street 1:3225 N CIVIC CENTER PLZ
Practice Address - Street 2:SUITE1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6919
Practice Address - Country:US
Practice Address - Phone:480-246-3000
Practice Address - Fax:480-246-3100
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN127376163W00000X
AZAP1917363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP34382Medicare UPIN
PA048992EKVMedicare PIN