Provider Demographics
NPI:1467027516
Name:GROS, WILMA
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:GROS
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 1:13246 DESIRE ST
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-4328
Mailing Address - Country:US
Mailing Address - Phone:225-773-6581
Mailing Address - Fax:
Practice Address - Street 1:321 NORTH CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2988
Practice Address - Country:US
Practice Address - Phone:225-265-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies