Provider Demographics
NPI:1154069607
Name:GROENENDAAL, ANN M
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:GROENENDAAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1637
Mailing Address - Country:US
Mailing Address - Phone:814-323-3259
Mailing Address - Fax:
Practice Address - Street 1:2653 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1637
Practice Address - Country:US
Practice Address - Phone:814-323-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula