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NPI Code Detail

MEDICARE: ANN ELIZABETH GROONWALD CNM

MEDICARE: ANN ELIZABETH GROONWALD CNM
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
1367A00000XAdvanced Practice Midwife236094CA
2163WM0102XMaternal Newborn Registered Nurse95141514CA
3367A00000XAdvanced Practice Midwife511MN

General Provider Information

NPI Number : 1497213151
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN ELIZABETH GROONWALD CNM
Provider Business Mailing Address
First Line : 2606 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3706
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2606 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3706
Country : US
Telephone Number : 612-545-5311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2019
Last Update Date : 08/25/2022

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