Provider Demographics
NPI:1992144208
Name:PUTERBAUGH, ROSS (ANP-C)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:
Last Name:PUTERBAUGH
Suffix:
Gender:M
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NE 139TH ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2309
Mailing Address - Country:US
Mailing Address - Phone:360-487-2727
Mailing Address - Fax:360-487-4849
Practice Address - Street 1:2101 NE 139TH ST
Practice Address - Street 2:SUITE 460
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2309
Practice Address - Country:US
Practice Address - Phone:360-487-2727
Practice Address - Fax:360-487-4849
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAARNP.AP.60378735-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health