Individual
WANDA RIGINA GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
R4805
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487192910
IRS EIN
MD
05
—
1487192910
—
MD
01
—
R4805
RESIDENTIAL SERVICES LICENSE
MD
Enumeration date
04/20/2018
Last updated
08/25/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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