Provider Demographics
NPI:1992929525
Name:ROSS, CARLENE B
Entity type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:B
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 1:131 HEATH RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-3119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 HEATH RD
Practice Address - Street 2:
Practice Address - City:CASCO
Practice Address - State:ME
Practice Address - Zip Code:04015-3119
Practice Address - Country:US
Practice Address - Phone:207-627-4106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant