Provider Demographics
NPI:1487439527
Name:EXTON ROSS, LINDA RENEE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:RENEE
Last Name:EXTON 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 1:1922 ROCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1428
Mailing Address - Country:US
Mailing Address - Phone:202-749-7964
Mailing Address - Fax:
Practice Address - Street 1:2515 ALABAMA AVE SE APT 105
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3220
Practice Address - Country:US
Practice Address - Phone:202-938-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401192469376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide