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 |