Individual
ALEXANDRA SHADE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
500 HOSPITAL DR, WETUMPKA, AL 36092-1625
(334) 567-4311
(334) 514-3686
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 567-4311
(334) 514-3686
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-152055
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04220120
AANP
AL
01
—
1-152055
ABN MEDICAL LICENSE
AL
05
—
285542
—
AL
Enumeration date
04/13/2022
Last updated
12/29/2022
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