Provider Demographics
NPI:1407846934
Name:GROSSMAN, VICKI LYNN (RN MSN APRN)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:RN MSN APRN
Other - Prefix:
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Mailing Address - Street 1:1915 NE STUCKI AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6951
Mailing Address - Country:US
Mailing Address - Phone:303-352-3316
Mailing Address - Fax:
Practice Address - Street 1:1915 NE STUCKI AVE STE 308
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6951
Practice Address - Country:US
Practice Address - Phone:303-352-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO93197163W00000X, 363LP0808X, 364S00000X
OR202207534NPPP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist