Provider Demographics
NPI:1033562277
Name:GROSSCUP, GINA ANN
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ANN
Last Name:GROSSCUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5849 KERR ROAD
Mailing Address - Street 2:
Mailing Address - City:GAMBIER
Mailing Address - State:OH
Mailing Address - Zip Code:43022
Mailing Address - Country:US
Mailing Address - Phone:740-501-0087
Mailing Address - Fax:
Practice Address - Street 1:5849 KERR ROAD
Practice Address - Street 2:
Practice Address - City:GAMBIER
Practice Address - State:OH
Practice Address - Zip Code:43022
Practice Address - Country:US
Practice Address - Phone:740-501-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19127363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner