Provider Demographics
NPI:1871893578
Name:GROSS, PIUS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:PIUS
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21931 W TWILIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8593
Mailing Address - Country:US
Mailing Address - Phone:623-386-5504
Mailing Address - Fax:
Practice Address - Street 1:6103 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5880
Practice Address - Country:US
Practice Address - Phone:480-947-4373
Practice Address - Fax:520-731-8001
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ051363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health