Healthcare Provider Details

I. General information

NPI: 1407300312
Provider Name (Legal Business Name): LINDA GROSS MS, RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 GOLFVIEW CT
MINT HILL NC
28227-9238
US

IV. Provider business mailing address

4917 GOLFVIEW CT
MINT HILL NC
28227-9238
US

V. Phone/Fax

Practice location:
  • Phone: 704-451-1597
  • Fax:
Mailing address:
  • Phone: 704-451-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberL001092
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: