Healthcare Provider Details

I. General information

NPI: 1407846934
Provider Name (Legal Business Name): VICKI LYNN GROSSMAN RN MSN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 NE STUCKI AVE STE 308
HILLSBORO OR
97006-6951
US

IV. Provider business mailing address

1915 NE STUCKI AVE STE 308
HILLSBORO OR
97006-6951
US

V. Phone/Fax

Practice location:
  • Phone: 303-352-3316
  • Fax:
Mailing address:
  • Phone: 303-352-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number93197
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number93197
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number93197
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202207534NPPP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: