Provider Demographics
NPI:1790056869
Name:GROSS, MARGARET DIANE (LPN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:DIANE
Last Name:GROSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2701
Mailing Address - Country:US
Mailing Address - Phone:585-359-4436
Mailing Address - Fax:
Practice Address - Street 1:25 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2701
Practice Address - Country:US
Practice Address - Phone:585-359-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2406321164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse