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General NPI Number Information
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NPI Number | 1902611064
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Entity Type | Individual
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Provider Name | AMY JO GROTEWOLD REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 2501 W 22ND ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1305
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Country | US
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Telephone | 605-261-7545
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Fax |
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Provider Business Mailing Address
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Address Line | 813 CHURCHILL DR
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City | LARCHWOOD
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State | IA
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Zip | 51241-7751
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Country | US
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Telephone | 605-261-7545
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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 | 1714065
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License Number State | MN
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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 | 104809
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License Number State | IA
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