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General NPI Number Information
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NPI Number | 1285926741
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Entity Type | Individual
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Provider Name | DENISE GROH CRISS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 633 BROOKDALE DR STE 100
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City | STATESVILLE
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State | NC
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Zip | 28677-3471
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Country | US
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Telephone | 704-978-1144
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Fax | 704-978-1148
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Provider Business Mailing Address
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Address Line | PO BOX 1845
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City | STATESVILLE
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State | NC
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Zip | 28687-1845
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Country | US
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Telephone | 704-873-4277
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Fax | 704-978-3549
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101133
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101133
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License Number State | NC
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