Provider Demographics
NPI:1124910351
Name:GROSS, LATONYA (RN)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 W 10 MILE RD STE 211-329
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2036
Mailing Address - Country:US
Mailing Address - Phone:248-606-8591
Mailing Address - Fax:
Practice Address - Street 1:15900 W 10 MILE RD STE 211-329
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2036
Practice Address - Country:US
Practice Address - Phone:248-606-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704233575163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse