Individual
MACHA J ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1330 N MAIN ST, TENNESSEE RIDGE, TN 37178-4003
(931) 721-3337
(931) 721-3308
Mailing address
1330 N MAIN ST, TENNESSEE RIDGE, TN 37178-4003
(931) 721-3337
(931) 721-3308
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPN0000049909
NURSING LICENSE
TN
Enumeration date
03/02/2007
Last updated
07/08/2007
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