Provider Demographics
NPI:1245536432
Name:GROSS, SUSAN B (FNP-BC, WHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:GROSS
Suffix:
Gender:F
Credentials:FNP-BC, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 UNA AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:CATHLAMET
Mailing Address - State:WA
Mailing Address - Zip Code:98612-9583
Mailing Address - Country:US
Mailing Address - Phone:360-795-3201
Mailing Address - Fax:360-795-3209
Practice Address - Street 1:799 LONG ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-3304
Practice Address - Country:US
Practice Address - Phone:541-367-3888
Practice Address - Fax:541-367-2407
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60527025363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health