Provider Demographics
NPI:1093314882
Name:GROSS, SHERRY RENEE
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:RENEE
Last Name:GROSS
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 1:2111 MATE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:RED JACKET
Mailing Address - State:WV
Mailing Address - Zip Code:25692
Mailing Address - Country:US
Mailing Address - Phone:606-625-2866
Mailing Address - Fax:
Practice Address - Street 1:2111 MATE CREEK ROAD
Practice Address - Street 2:
Practice Address - City:RED JACKET
Practice Address - State:WV
Practice Address - Zip Code:25692
Practice Address - Country:US
Practice Address - Phone:606-625-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant