Healthcare Provider Details

I. General information

NPI: 1245536432
Provider Name (Legal Business Name): SUSAN B GROSS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 SCOON RD
SUNNYSIDE WA
98944-1031
US

IV. Provider business mailing address

10024 SE 240TH ST STE 201
KENT WA
98031-5124
US

V. Phone/Fax

Practice location:
  • Phone: 509-837-8200
  • Fax:
Mailing address:
  • Phone: 253-859-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60527025
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: