Provider Demographics
NPI:1104837418
Name:GROSS, WENDY RENEE (RN)
Entity Type:Individual
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First Name:WENDY
Middle Name:RENEE
Last Name:GROSS
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:7373 FRANCE AVE S
Practice Address - Street 2:SUITE 312
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4534
Practice Address - Country:US
Practice Address - Phone:952-832-0076
Practice Address - Fax:952-832-0477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-10
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Provider Licenses
StateLicense IDTaxonomies
MNR1369119364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
73B60ROOtherBLUE CROSS BLUE SHIELD