Provider Demographics
NPI:1871109256
Name:GROSS, JESSICA (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3758 GRIFFITH AVE APT SUITE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1439
Mailing Address - Country:US
Mailing Address - Phone:248-930-6134
Mailing Address - Fax:
Practice Address - Street 1:6089 W MAPLE RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2286
Practice Address - Country:US
Practice Address - Phone:248-851-1600
Practice Address - Fax:248-851-0421
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2022-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601010866363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical