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NPI Code Detail

MEDICARE: GLENDA JANICE GROVENBERRY

MEDICARE: GLENDA JANICE GROVENBERRY
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner71010172AIN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner28138340AIN

General Provider Information

NPI Number : 1295343689
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENDA JANICE GROVENBERRY
Provider Business Mailing Address
First Line : 9615 E 148TH ST STE 1
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46060-4371
Country : US
Telephone Number : 317-574-1254
Fax Number : 317-674-0060
Provider Business Practice Location Address
First Line : 17840 CUMBERLAND RD
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46060-5409
Country : US
Telephone Number : 317-574-1254
Fax Number : 317-674-0060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2020
Last Update Date : 03/12/2026

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Directions to “ GLENDA JANICE GROVENBERRY ” Practice Location

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