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General NPI Number Information
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NPI Number | 1407846934
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Entity Type | Individual
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Provider Name | VICKI LYNN GROSSMAN RN MSN APRN
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 1915 NE STUCKI AVE STE 308
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City | HILLSBORO
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State | OR
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Zip | 97006-6951
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Country | US
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Telephone | 303-352-3316
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 NE STUCKI AVE STE 308
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City | HILLSBORO
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State | OR
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Zip | 97006-6951
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Country | US
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Telephone | 303-352-3316
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 93197
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 93197
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 93197
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202207534NPPP
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License Number State | OR
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