Provider Demographics
NPI:1235234915
Name:GROTBO, ANNA CHRISTINE (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CHRISTINE
Last Name:GROTBO
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7303
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-7303
Mailing Address - Country:US
Mailing Address - Phone:406-315-3503
Mailing Address - Fax:406-315-3505
Practice Address - Street 1:2517 7TH AVE S
Practice Address - Street 2:B-3
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3032
Practice Address - Country:US
Practice Address - Phone:406-315-3503
Practice Address - Fax:406-315-3505
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN16364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP98810Medicare UPIN