Healthcare Provider Details

I. General information

NPI: 1639302789
Provider Name (Legal Business Name): ROBERT KIM GROSSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 EXECUTIVE DR SUITE F
DANVILLE VA
24541-4160
US

IV. Provider business mailing address

159 EXECUTIVE DRIVE SUITE F
DANVILLE VA
24541-4160
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-4378
  • Fax: 434-799-0860
Mailing address:
  • Phone: 434-792-4378
  • Fax: 434-799-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0024168401
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024168401
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: