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NPI Code Detail

MEDICARE: MRS. VICKI LYNN GROSSMAN RN MSN APRN

MEDICARE: MRS. VICKI LYNN GROSSMAN RN MSN APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse93197CO
2363LP0808XPsychiatric/Mental Health Nurse Practitioner93197CO
3364S00000XClinical Nurse Specialist93197CO
4363LP0808XPsychiatric/Mental Health Nurse Practitioner202207534NPPPOR

General Provider Information

NPI Number : 1407846934
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VICKI LYNN GROSSMAN RN MSN APRN
Provider Business Mailing Address
First Line : 1915 NE STUCKI AVE STE 308
Second Line :
City : HILLSBORO
State : OR
Zip : 97006-6951
Country : US
Telephone Number : 303-352-3316
Fax Number :
Provider Business Practice Location Address
First Line : 1915 NE STUCKI AVE STE 308
Second Line :
City : HILLSBORO
State : OR
Zip : 97006-6951
Country : US
Telephone Number : 303-352-3316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 10/30/2023

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