Provider Demographics
NPI:1336127398
Name:GROSS, ROSALYN (ARNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ROSALYN
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6542 SE LAKE RD
Mailing Address - Street 2:#202
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2244
Mailing Address - Country:US
Mailing Address - Phone:503-654-5636
Mailing Address - Fax:
Practice Address - Street 1:6542 SE LAKE RD
Practice Address - Street 2:#202
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2244
Practice Address - Country:US
Practice Address - Phone:503-654-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201250113NP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303006700Medicaid
FL303006700Medicaid
FLE3263XMedicare UPIN