Provider Demographics
NPI:1952973968
Name:GROSSER, JILLIAN MICHELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MICHELLE
Last Name:GROSSER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 GERHARD DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3284
Mailing Address - Country:US
Mailing Address - Phone:859-620-9622
Mailing Address - Fax:
Practice Address - Street 1:513 GERHARD DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3284
Practice Address - Country:US
Practice Address - Phone:859-620-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY147884367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered