Provider Demographics
NPI:1770473092
Name:ROSS, CLARE KATARINA (AG-ACNP)
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:KATARINA
Last Name:ROSS
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5147 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5441
Mailing Address - Country:US
Mailing Address - Phone:916-303-3039
Mailing Address - Fax:
Practice Address - Street 1:5147 ILLINOIS AVE # CA95628
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-5441
Practice Address - Country:US
Practice Address - Phone:916-303-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035636363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care