Provider Demographics
NPI:1114320710
Name:GROSSMANN, DAMARIS (APRN, DNP , FNP-C)
Entity Type:Individual
Prefix:PROF
First Name:DAMARIS
Middle Name:
Last Name:GROSSMANN
Suffix:
Gender:F
Credentials:APRN, DNP , FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SANTIAGO AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1640
Mailing Address - Country:US
Mailing Address - Phone:732-501-8349
Mailing Address - Fax:
Practice Address - Street 1:150 SANTIAGO AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1640
Practice Address - Country:US
Practice Address - Phone:732-501-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-27
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26700848400363L00000X
NJ26NJ00848400363LF0000X
NJ26NR16088800163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1114320710Medicaid