Provider Demographics
NPI:1366962490
Name:ROSS, DONNA ANNETTE
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:ANNETTE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 N 28TH WEST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-5111
Mailing Address - Country:US
Mailing Address - Phone:918-619-5132
Mailing Address - Fax:
Practice Address - Street 1:614 N 28TH WEST PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-5111
Practice Address - Country:US
Practice Address - Phone:918-619-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator