| NPI | 1790453744 |
|---|---|
| Professional Name | KELLY DIANE GROSSMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 8457) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 8457) |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2022-08-12 |