Provider Demographics
NPI:1992024285
Name:GROSSMAN, EVE (LCC AC, RN)
Entity Type:Individual
Prefix:MISS
First Name:EVE
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LCC AC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 E BOULDER CANYON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325
Mailing Address - Country:US
Mailing Address - Phone:928-634-7104
Mailing Address - Fax:
Practice Address - Street 1:5000 E BOULDER CANYON DRIVE
Practice Address - Street 2:
Practice Address - City:CORNVILLE
Practice Address - State:AZ
Practice Address - Zip Code:86325
Practice Address - Country:US
Practice Address - Phone:928-634-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist