Provider Demographics
NPI:1790305845
Name:GROSS, MERRY CATHERINE (CRNA)
Entity Type:Individual
Prefix:
First Name:MERRY
Middle Name:CATHERINE
Last Name:GROSS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MERRY
Other - Middle Name:CATHERINE
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2245 REILING RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1023
Mailing Address - Country:US
Mailing Address - Phone:815-871-4568
Mailing Address - Fax:
Practice Address - Street 1:2245 REILING RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-1023
Practice Address - Country:US
Practice Address - Phone:815-871-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2478247163W00000X
MN143897367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse