Provider Demographics
NPI:1174170021
Name:ROSS, JA SHALA LYNN
Entity type:Individual
Prefix:MS
First Name:JA SHALA
Middle Name:LYNN
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 1:14-SOUTHARD AVE. 303
Mailing Address - Street 2:303
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604
Mailing Address - Country:US
Mailing Address - Phone:419-902-9991
Mailing Address - Fax:
Practice Address - Street 1:1403 LINCOLN AVE LOWR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-1811
Practice Address - Country:US
Practice Address - Phone:419-902-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501016130805376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide