Individual
MISS LISA NICOLE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
4410 PENNSYLVANIA AVE APT 4, KANSAS CITY, MO 64111-3323
(785) 766-5412
Mailing address
4410 PENNSYLVANIA AVE APT 4, KANSAS CITY, MO 64111-3323
(785) 766-5412
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
24-00642
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24-00642
KANSAS STATE BOARD OF HEALING ARTS
KS
Enumeration date
01/22/2009
Last updated
01/22/2009
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