Provider Demographics
NPI:1134291693
Name:GROSSO, NANCY ANN (RN, MS, FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:GROSSO
Suffix:
Gender:F
Credentials:RN, MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 MILITARY ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6692
Mailing Address - Country:US
Mailing Address - Phone:810-984-5700
Mailing Address - Fax:810-984-1886
Practice Address - Street 1:2425 MILITARY ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6692
Practice Address - Country:US
Practice Address - Phone:810-984-5700
Practice Address - Fax:810-984-1886
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159116363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily