Provider Demographics
NPI:1669701736
Name:GROSS, AMBER S (NP-PP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:S
Last Name:GROSS
Suffix:
Gender:F
Credentials:NP-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-0445
Mailing Address - Fax:541-574-6252
Practice Address - Street 1:1010 SW COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5288
Practice Address - Country:US
Practice Address - Phone:541-265-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006255363LF0000X
OR201500367NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201500366RNOtherRN
ORF1009203OtherAANP
OR201500367NP-PPOtherNP-PP
OR500682364Medicaid