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General NPI Number Information
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NPI Number | 1982162384
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Entity Type | Individual
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Provider Name | NICOLE R GROETKEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 11333 AURORA AVE
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City | URBANDALE
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State | IA
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Zip | 50322-7908
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Country | US
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Telephone | 515-557-3120
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Fax | 515-557-3125
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Provider Business Mailing Address
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Address Line | 11333 AURORA AVE
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City | URBANDALE
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State | IA
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Zip | 50322-7908
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Country | US
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Telephone | 515-557-3120
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Fax | 515-557-3125
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 11
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License Number State | IA
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