Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 307072 | NY |
NPI | 1023416740 |
---|---|
Provider Name | Ms. Renee Groh |
First Address | Brentwood, TN 37027-5064 |
Second Address | Warsaw, NY 14569-1025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2014 |
Last Update Date | 05/02/2019 |