Individual
MIA ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2233 STATE ROUTE 86, ONCOLOGY DEPT, SARANAC LAKE, NY 12983-5644
(518) 897-2879
(518) 891-5248
Mailing address
2233 STATE ROUTE 86, SARANAC LAKE, NY 12983-5644
(518) 897-2879
(518) 891-5248
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
F302382
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00363213
—
NY
01
—
141731786
TAX ID
NY
01
—
F302382
LICENSE
NY
Enumeration date
04/03/2007
Last updated
03/07/2023
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