Individual
VICKY JO GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4600 W WASHINGTON ST, SOUTH BEND, IN 46619-2320
(574) 282-1294
Mailing address
140 CANARIS ST, CONSTANTINE, MI 49042-1016
(269) 464-9118
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
4704270659
MI
363LA2200X
Adult Health Nurse Practitioner
Primary
71011297A
IN
Other
Enumeration date
11/16/2020
Last updated
07/22/2021
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