Provider Demographics
NPI:1083962401
Name:GROSS, MEGAN M (ARNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:GROSS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:SOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 KELLY LN
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-8542
Mailing Address - Country:US
Mailing Address - Phone:952-270-8260
Mailing Address - Fax:
Practice Address - Street 1:3375 LAKE RIDGE DR.
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003
Practice Address - Country:US
Practice Address - Phone:952-270-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA129015163W00000X
IAB129015363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse