Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | CNP 0422 | MN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R104949 | MN |
NPI | 1003190372 |
---|---|
Provider Name | Joan Grotewold |
First Address | Rochester, MN 55901-4717 |
Second Address | Rochester, MN 55901-4717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2011 |
Last Update Date | 01/02/2017 |