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NPI Code Detail

MEDICARE: NICOLE DENISE GROSS QMHS

MEDICARE: NICOLE DENISE GROSS QMHS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1902305816
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE DENISE GROSS QMHS
Provider Business Mailing Address
First Line : 500 MADISON AVE STE 300
Second Line :
City : TOLEDO
State : OH
Zip : 43604-1257
Country : US
Telephone Number : 567-312-8700
Fax Number : 567-312-8793
Provider Business Practice Location Address
First Line : 500 MADISON AVE STE 300
Second Line :
City : TOLEDO
State : OH
Zip : 43604-1257
Country : US
Telephone Number : 567-312-8700
Fax Number : 567-312-8793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2018
Last Update Date : 02/06/2018

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Directions to “ NICOLE DENISE GROSS QMHS” Practice Location

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