Provider Demographics
NPI:1366410979
Name:ROSS, MAUREEN (NP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4628
Mailing Address - Country:US
Mailing Address - Phone:703-280-5390
Mailing Address - Fax:703-280-9596
Practice Address - Street 1:8503 ARLINGTON BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4628
Practice Address - Country:US
Practice Address - Phone:703-280-5390
Practice Address - Fax:703-280-9596
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024108374363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS96472Medicare UPIN