Provider Demographics
NPI:1982654646
Name:GROSS, TODD ARLEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ARLEN
Last Name:GROSS
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1601 64TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-6036
Mailing Address - Country:US
Mailing Address - Phone:701-232-6544
Mailing Address - Fax:701-232-6544
Practice Address - Street 1:2301 25TH ST S STE K
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6104
Practice Address - Country:US
Practice Address - Phone:701-234-1728
Practice Address - Fax:701-234-1681
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NDR14737367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered