Individual
AMANDA JEAN GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-8000
(701) 364-8078
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
R176928-5
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
R30715
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15472
—
ND
Enumeration date
09/20/2010
Last updated
04/20/2012
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