Healthcare Provider Details

I. General information

NPI: 1104332469
Provider Name (Legal Business Name): JONATHAN GROSCHEL R.N., R.N.F.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 12/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TRANCAS ST
NAPA CA
94558-2906
US

IV. Provider business mailing address

1457 DIAMOND WOODS CIR
ROSEVILLE CA
95747-4600
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-4411
  • Fax:
Mailing address:
  • Phone: 707-708-1216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number799229
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number799229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: