Healthcare Provider Details

I. General information

NPI: 1003190372
Provider Name (Legal Business Name): JOAN GROTEWOLD APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5067 55TH ST SW
ROCHESTER MN
55901-4717
US

IV. Provider business mailing address

5067 55TH ST SW
ROCHESTER MN
55901-4717
US

V. Phone/Fax

Practice location:
  • Phone: 507-292-7070
  • Fax:
Mailing address:
  • Phone: 507-292-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR104949
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP 0422
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: