Provider Demographics
NPI:1932723608
Name:GROSS, BRIANNA LEE
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEE
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6276 CORWIN STA
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-9727
Mailing Address - Country:US
Mailing Address - Phone:716-417-0865
Mailing Address - Fax:
Practice Address - Street 1:5544 MAIN ST # 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5406
Practice Address - Country:US
Practice Address - Phone:716-580-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program