Provider Demographics
NPI:1104025493
Name:GROTHE, JOLENE (APRN, CDE)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:GROTHE
Suffix:
Gender:F
Credentials:APRN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 E 32ND ST N STE 125
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2644
Mailing Address - Country:US
Mailing Address - Phone:316-330-3636
Mailing Address - Fax:
Practice Address - Street 1:8110 E 32ND ST N STE 125
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2644
Practice Address - Country:US
Practice Address - Phone:316-330-3636
Practice Address - Fax:866-378-4552
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39536163WD0400X
KS75008363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator