Provider Demographics
NPI:1922149533
Name:GROSS, MARY JANE (RN, MN)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:RN, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ARROYO AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3913
Mailing Address - Country:US
Mailing Address - Phone:510-428-2240
Mailing Address - Fax:
Practice Address - Street 1:45 ARROYO AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94611-3913
Practice Address - Country:US
Practice Address - Phone:510-428-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI239389163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health