Healthcare Provider Details

I. General information

NPI: 1326302795
Provider Name (Legal Business Name): KRISTINA M GROSS RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 4TH AVE S
SAINT CLOUD MN
56301-4442
US

IV. Provider business mailing address

720 4TH AVE S
SAINT CLOUD MN
56301-4498
US

V. Phone/Fax

Practice location:
  • Phone: 320-308-3193
  • Fax: 320-308-3192
Mailing address:
  • Phone: 320-308-3193
  • Fax: 320-308-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR-1401585
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: