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General NPI Number Information
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NPI Number | 1801177605
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Entity Type | Individual
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Provider Name | PRENTIS RAE GROSS NP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 1040 MEDICAL PARK AVE
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City | NEW BERN
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State | NC
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Zip | 28562-5248
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Country | US
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Telephone | 252-633-1678
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Fax | 252-633-1403
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Provider Business Mailing Address
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Address Line | PO BOX 12248
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City | NEW BERN
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State | NC
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Zip | 28561-2248
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Country | US
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Telephone | 252-636-6222
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Fax | 252-636-5385
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5005290
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License Number State | NC
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