Provider Demographics
NPI:1073378162
Name:DAMIANI-GROCHOWSKI, LUANN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:DAMIANI-GROCHOWSKI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 WHITEHALL PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4179
Mailing Address - Country:US
Mailing Address - Phone:917-576-1186
Mailing Address - Fax:
Practice Address - Street 1:3545 WHITEHALL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4179
Practice Address - Country:US
Practice Address - Phone:917-576-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019730363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health