Healthcare Provider Details

I. General information

NPI: 1417993320
Provider Name (Legal Business Name): CATHERINE ANN GROEGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 HIGHWAY 51 STE. #4
PONCHATOULA LA
70454-6376
US

IV. Provider business mailing address

1450 COTTONWOOD DR
DENHAM SPRINGS LA
70726-2741
US

V. Phone/Fax

Practice location:
  • Phone: 985-386-3405
  • Fax:
Mailing address:
  • Phone: 225-665-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN036756 AP01798
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: