Provider Demographics
NPI:1023713021
Name:WALERI, ROSS ALLEN
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:ALLEN
Last Name:WALERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 1/2 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4005
Mailing Address - Country:US
Mailing Address - Phone:701-952-0397
Mailing Address - Fax:
Practice Address - Street 1:428 1/2 2ND ST SW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4005
Practice Address - Country:US
Practice Address - Phone:701-320-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDDUM00000175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist