Provider Demographics
NPI:1659563344
Name:GROSS, MARY SOBNOSKY (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SOBNOSKY
Last Name:GROSS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:416 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2853
Mailing Address - Country:US
Mailing Address - Phone:919-382-2819
Mailing Address - Fax:919-382-2029
Practice Address - Street 1:416 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2853
Practice Address - Country:US
Practice Address - Phone:919-382-2819
Practice Address - Fax:919-382-2029
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000615133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist