MEDICARE: ASHLEY GROSS FNP-C

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
1	363LF0000X	Family Nurse Practitioner	15340	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.15340	OH

General Provider Information

NPI Number	:	1174952204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GROSS FNP-C

Provider Business Mailing Address
First Line	:	8179 SAPPHIRE AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-1779
Country	:	US
Telephone Number	:	330-754-5439
Fax Number	:

Provider Business Practice Location Address
First Line	:	8179 SAPPHIRE AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-1779
Country	:	US
Telephone Number	:	330-754-5439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	08/31/2016

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