Provider Demographics
NPI:1205905221
Name:GROSE, KANDIS L (MS, RD, LN)
Entity type:Individual
Prefix:
First Name:KANDIS
Middle Name:L
Last Name:GROSE
Suffix:
Gender:F
Credentials:MS, RD, LN
Other - Prefix:
Other - First Name:KANDIS
Other - Middle Name:L
Other - Last Name:WESSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LN
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-0044
Mailing Address - Country:US
Mailing Address - Phone:406-839-3851
Mailing Address - Fax:
Practice Address - Street 1:649 MIDDLE BURNT FORK RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3895
Practice Address - Country:US
Practice Address - Phone:406-839-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0280857OtherMDCD PIN
MT011000076Medicare PIN