Individual
SYREETA LYNN VAN ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16659 E 23RD ST S, INDEPENDENCE, MO 64055-1922
(816) 631-1885
Mailing address
PO BOX 740019, ATLANTA, GA 30374-0019
(773) 644-3941
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
200380880A
KS
363LF0000X
Family Nurse Practitioner
Primary
2015039584
MO
363LP2300X
Primary Care Nurse Practitioner
2015039584
MO
363LP2300X
Primary Care Nurse Practitioner
77550-072
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200380880A
—
KS
Enumeration date
03/24/2007
Last updated
11/10/2025
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