Provider Demographics
NPI:1639370687
Name:GROSS, JOANNE MARYJANE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:MARYJANE
Last Name:GROSS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:MARYJANE
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1538
Mailing Address - Street 2:4651 GRAFORD LANE
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-0538
Mailing Address - Country:US
Mailing Address - Phone:330-678-7650
Mailing Address - Fax:
Practice Address - Street 1:4651 GRAFORD LN
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2020
Practice Address - Country:US
Practice Address - Phone:330-678-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.111843163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.111843OtherRN LICENSE -COA1