Provider Demographics
NPI:1962951509
Name:GROSE, EMILY (CNM)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GROSE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 BELMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-257-0341
Mailing Address - Fax:
Practice Address - Street 1:21 BELMONT AVENUE, GANNETT BUILDING 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-0530
Practice Address - Country:US
Practice Address - Phone:802-251-8787
Practice Address - Fax:802-251-9972
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNCNM0356367A00000X, 367A00000X
VT1010134331363L00000X
OR201507617RN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3121719Medicaid
VT6701695Medicaid