Individual
LILLIE NICOLE ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-8906
(317) 944-8906
Mailing address
PO BOX 778912, CHICAGO, IL 60677-8912
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004164A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300082752
—
IN
Enumeration date
12/30/2022
Last updated
11/15/2023
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