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General NPI Number Information
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NPI Number | 1932723608
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Entity Type | Individual
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Provider Name | BRIANNA LEE GROSS
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Gender | Female
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 5544 MAIN ST # 2
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5406
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Country | US
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Telephone | 716-580-3976
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Fax |
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Provider Business Mailing Address
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Address Line | 6276 CORWIN STA
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City | NEWFANE
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State | NY
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Zip | 14108-9727
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Country | US
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Telephone | 716-417-0865
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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