Provider Demographics
NPI:1255760583
Name:GROSS, PATRICIA (LPN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 N COTTAGE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-9084
Mailing Address - Country:US
Mailing Address - Phone:989-567-2077
Mailing Address - Fax:
Practice Address - Street 1:460 N COTTAGE AVE APT A
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MI
Practice Address - Zip Code:48883-9084
Practice Address - Country:US
Practice Address - Phone:989-567-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703054533164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse