Provider Demographics
NPI:1548637788
Name:GROSSO, CHRISTINE (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GROSSO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 SPROUL RD STE 625
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3524
Mailing Address - Country:US
Mailing Address - Phone:610-325-0309
Mailing Address - Fax:610-325-0459
Practice Address - Street 1:1991 SPROUL RD STE 625
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3524
Practice Address - Country:US
Practice Address - Phone:610-325-0309
Practice Address - Fax:610-325-0459
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015147363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMLHC TIN