Provider Demographics
NPI:1417405630
Name:GROSSO, ASHLEY MAE (LPN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MAE
Last Name:GROSSO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 S I ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-4412
Mailing Address - Country:US
Mailing Address - Phone:253-282-9858
Mailing Address - Fax:
Practice Address - Street 1:7011 S I ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408
Practice Address - Country:US
Practice Address - Phone:253-282-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60447577164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA164W00000XMedicaid