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General NPI Number Information
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NPI Number | 1073906913
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Entity Type | Individual
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Provider Name | ANNA MORIAH GROTE CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 20 MEDICAL VILLAGE DR
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City | EDGEWOOD
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State | KY
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Zip | 41017-5401
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Country | US
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Telephone | 859-341-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 3106 ASPEN PINES DRIVE
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City | WILDER
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State | KY
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Zip | 41071
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Country | US
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Telephone | 304-546-8046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 78754
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 376533
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1143511
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License Number State | KY
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