Individual
JEREMY DANIEL ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11582 C ST, JOINT BASE LEWIS-MCCHORD, WA 98433
(253) 966-7574
Mailing address
4720 S PINE ST APT J134, TACOMA, WA 98409-6444
(253) 353-1443
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
225012
TX
Other
Enumeration date
03/29/2016
Last updated
03/29/2016
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