Provider Demographics
NPI:1063383602
Name:CROSGROVE, GLORIA JEAN
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:CROSGROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:JEAN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:NE
Mailing Address - Zip Code:68757
Mailing Address - Country:US
Mailing Address - Phone:605-450-5769
Mailing Address - Fax:
Practice Address - Street 1:104 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:NE
Practice Address - Zip Code:68757
Practice Address - Country:US
Practice Address - Phone:605-450-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant