MEDICARE: JENNIFER LYNN GROTHAUSE

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	163W00000X	Registered Nurse	RN.379980	OH

General Provider Information

NPI Number	:	1881959559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN GROTHAUSE

Provider Business Mailing Address
First Line	:	1401 BROADVIEW AVE
Second Line	:	APARTMENT 11
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2846
Country	:	US
Telephone Number	:	614-565-4788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 BROADVIEW AVE
Second Line	:	APARTMENT 11
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2846
Country	:	US
Telephone Number	:	614-565-4788
Fax Number	:

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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