MEDICARE: DORIANN LORRAINE GRUHLKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	225700000X	Massage Therapist	MT.0019386	CO

General Provider Information

NPI Number	:	1700226453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIANN LORRAINE GRUHLKE

Provider Business Mailing Address
First Line	:	121 2ND ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2510
Country	:	US
Telephone Number	:	970-818-0578
Fax Number	:

Provider Business Practice Location Address
First Line	:	1337 E PROSPECT RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1115
Country	:	US
Telephone Number	:	970-818-0578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	03/17/2018

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