Provider Demographics
NPI:1689697682
Name:GROSS, DEAN A (NP)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:GROSS
Suffix:
Gender:M
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 VIKING AVENUE
Practice Address - Street 2:
Practice Address - City:ULEN
Practice Address - State:MN
Practice Address - Zip Code:56585
Practice Address - Country:US
Practice Address - Phone:218-596-8867
Practice Address - Fax:218-596-8112
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR20421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S47592Medicare UPIN