Provider Demographics
NPI:1477883312
Name:GROSS, JENETHA RENEE (STNA)
Entity Type:Individual
Prefix:MS
First Name:JENETHA
Middle Name:RENEE
Last Name:GROSS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MS
Other - First Name:JENETHA12
Other - Middle Name:RENEE
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STNA
Mailing Address - Street 1:2464 GREENVALE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1117
Mailing Address - Country:US
Mailing Address - Phone:216-773-7665
Mailing Address - Fax:
Practice Address - Street 1:2464 GREENVALE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-1117
Practice Address - Country:US
Practice Address - Phone:216-773-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH375204091195376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide