Provider Demographics
NPI:1437270584
Name:GROSSAN, GERI LYNN
Entity Type:Individual
Prefix:
First Name:GERI LYNN
Middle Name:
Last Name:GROSSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 LEAVORITE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4094
Mailing Address - Country:US
Mailing Address - Phone:702-242-5730
Mailing Address - Fax:702-242-1417
Practice Address - Street 1:7721 LEAVORITE DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-242-5730
Practice Address - Fax:702-242-1417
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered