Individual
STACY ANN GROSSMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
12593 LOWER SYLVAN RD SW, PILLAGER, MN 56473-2267
(218) 831-8152
Mailing address
12593 LOWER SYLVAN RD SW, PILLAGER, MN 56473-2267
(218) 831-8152
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
7591
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7591
MEDICAID
MN
05
—
7591
—
MN
Enumeration date
08/28/2020
Last updated
04/11/2024
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