| Doctor Name: | MS. MARYA E GROSSE |
| NPI Number: | 1275802100 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 528925 |
| Business Practice Address: | 6 Tarman Dr Cloverdale, CA - 954253932 |
| Business Phone Number: | 7078944229 |
| Business Fax Number: | 7078942954 |
| Mailing Address: | 100 W 3rd St, CLOVERDALE |
| State: | CA |
| Postal Code: | 954253204 |
| Phone Number: | 7078944229 |
| Fax Number: | 7078947820 |
| NPI Enumeration Date: | 12/21/2011 |
| NPI Last Update Date: | 12/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 528925 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |