Healthcare Provider Details

I. General information

NPI: 1730883059
Provider Name (Legal Business Name): MARSHA GROSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 WATERFORD BLVD
EVANSVILLE IN
47715-2869
US

IV. Provider business mailing address

6211 WATERFORD BLVD
EVANSVILLE IN
47715-2869
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-7177
  • Fax:
Mailing address:
  • Phone: 812-997-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number28172746A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: