Individual
MR. SAMUEL NORMAN GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS.RD.LD
Contact information
Practice address
415 BEVERLY DR, ELLINWOOD, KS 67526-1419
(620) 564-2922
(620) 564-2922
Mailing address
4501 HOOVER DR, HAYS, KS 67601-1690
(620) 617-8247
(888) 617-8247
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
1236
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120533
BLUE CROSS NUTRITIONIST
KS
05
—
200366270B
—
KS
Enumeration date
05/30/2006
Last updated
04/24/2018
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