Individual
JOHANNA LOUISE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7901 S 6TH ST, OAK CREEK, WI 53154-2010
(414) 346-8000
Mailing address
4963 N 125TH ST, BUTLER, WI 53007-1532
(262) 370-7460
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9156-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9156-33
—
WI
Enumeration date
03/20/2019
Last updated
03/20/2019
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