Healthcare Provider Details

I. General information

NPI: 1730239096
Provider Name (Legal Business Name): AIMEE L GROSS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 SW MULVANE STE 104
TOPEKA KS
66606
US

IV. Provider business mailing address

PO BOX 1657
TOPEKA KS
66601-1657
US

V. Phone/Fax

Practice location:
  • Phone: 785-295-5498
  • Fax: 785-231-5991
Mailing address:
  • Phone: 785-295-5328
  • Fax: 785-231-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number74593
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: