Provider Demographics
NPI:1992165880
Name:GROSS, PATRICIA (LM)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM
Mailing Address - Street 1:520 OAK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:TX
Mailing Address - Zip Code:76071-3144
Mailing Address - Country:US
Mailing Address - Phone:817-366-4562
Mailing Address - Fax:682-831-9979
Practice Address - Street 1:309 N PINE ST # 103
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-6637
Practice Address - Country:US
Practice Address - Phone:817-366-4562
Practice Address - Fax:682-831-9979
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99264176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife