MEDICARE: EMILY GROUT FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704313203	MI

General Provider Information

NPI Number	:	1265058390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY GROUT FNP

Provider Business Mailing Address
First Line	:	1985 GRATIOT BLVD
Second Line	:
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-2215
Country	:	US
Telephone Number	:	810-216-1200
Fax Number	:	810-364-0698

Provider Business Practice Location Address
First Line	:	1985 GRATIOT BLVD
Second Line	:
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-2215
Country	:	US
Telephone Number	:	810-216-1200
Fax Number	:	810-364-0698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	03/31/2023

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