Healthcare Provider Details

I. General information

NPI: 1255738530
Provider Name (Legal Business Name): ABBIE JO GROSS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S NIAGARA ST
SAGINAW MI
48602-1570
US

IV. Provider business mailing address

1225 E. BIG BEAVER RD
TROY MI
48083
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-0066
  • Fax: 989-799-6867
Mailing address:
  • Phone: 248-524-8801
  • Fax: 248-524-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704308258
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: