Individual
DEVAN GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 MISSOURI AVE, BISMARCK, ND 58504-5264
(701) 258-7838
Mailing address
1200 MISSOURI AVE, BISMARCK, ND 58504-5264
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1481073
—
ND
Enumeration date
05/03/2022
Last updated
06/23/2022
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