Provider Demographics
NPI:1144077280
Name:GROSSCUP, LINDSAY (NP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:GROSSCUP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 PLUM CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-2726
Mailing Address - Country:US
Mailing Address - Phone:224-402-0713
Mailing Address - Fax:
Practice Address - Street 1:616 PLUM CT UNIT B
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-2726
Practice Address - Country:US
Practice Address - Phone:224-402-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029897363LF0000X
IL041479705163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily