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NPI Code Detail

MEDICARE: MISS JERRI LYNNE GROSSER MHA III

MEDICARE: MISS JERRI LYNNE GROSSER MHA III
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health WorkerCA

General Provider Information

NPI Number : 1174651822
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JERRI LYNNE GROSSER MHA III
Provider Business Mailing Address
First Line : 600 BERCUT DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95811-0131
Country : US
Telephone Number : 916-440-1500
Fax Number : 916-440-1514
Provider Business Practice Location Address
First Line : 600 BERCUT DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95811-0131
Country : US
Telephone Number : 916-440-1500
Fax Number : 916-440-1514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 05/17/2024

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