Provider Demographics
NPI:1568716835
Name:GROSSMAN, MERLYN ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:MERLYN
Middle Name:ANN
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9632 LUCERNE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2938
Mailing Address - Country:US
Mailing Address - Phone:310-815-9543
Mailing Address - Fax:
Practice Address - Street 1:9632 LUCERNE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2938
Practice Address - Country:US
Practice Address - Phone:310-815-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily