MEDICARE: DAWN MARIE GROFF NP

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	363LW0102X	Women's Health Nurse Practitioner	AP0340	AZ
2	363LP2300X	Primary Care Nurse Practitioner	AP74244	AZ

General Provider Information

NPI Number	:	1548234404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN MARIE GROFF NP

Provider Business Mailing Address
First Line	:	1684 E BOSTON ST STE 102
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-6220
Country	:	US
Telephone Number	:	804-448-2411
Fax Number	:	480-476-8718

Provider Business Practice Location Address
First Line	:	1684 E BOSTON ST STE 102
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-6220
Country	:	US
Telephone Number	:	804-448-2411
Fax Number	:	480-476-8718

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	03/03/2020

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Directions to “ DAWN MARIE GROFF NP” Practice Location

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