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General NPI Number Information
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NPI Number | 1952372559
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Entity Type | Individual
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Provider Name | JENNIFER M GROSS
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Gender | Female
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 14 CHESTNUT PLACE
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City | LUDLOW
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State | MA
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Zip | 01056
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Country | US
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Telephone | 413-589-7581
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 391 INNOVATIVE PHYSICIAN SERVICES LLC
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City | WILBRAHAM
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State | MA
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Zip | 01095-0391
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Country | US
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Telephone | 508-595-0531
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Fax | 508-829-5367
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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 | PA1861
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License Number State | MA
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