Provider Demographics
NPI:1548416233
Name:GROSS, GLENDA ARLENE (RN)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:ARLENE
Last Name:GROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 EAST 6TH STREET
Mailing Address - Street 2:PO BOX 879
Mailing Address - City:MCLAUGHLIN
Mailing Address - State:SD
Mailing Address - Zip Code:57642
Mailing Address - Country:US
Mailing Address - Phone:605-823-4459
Mailing Address - Fax:605-823-4460
Practice Address - Street 1:701 EAST 6TH STREET
Practice Address - Street 2:
Practice Address - City:MCLAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642
Practice Address - Country:US
Practice Address - Phone:605-823-4459
Practice Address - Fax:605-823-4460
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR242662163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health