Healthcare Provider Details

I. General information

NPI: 1104025493
Provider Name (Legal Business Name): JOLENE GROTHE APRN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 E 32ND ST N STE 125
WICHITA KS
67226-2644
US

IV. Provider business mailing address

8110 E 32ND ST N STE 125
WICHITA KS
67226-2644
US

V. Phone/Fax

Practice location:
  • Phone: 316-330-3636
  • Fax: 866-378-4552
Mailing address:
  • Phone: 316-330-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number39536
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75008
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: