Provider Demographics
NPI:1306203062
Name:GROTHAUS, ROCHELLE (RN)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:GROTHAUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 CONFER RD
Mailing Address - Street 2:
Mailing Address - City:KALAMA
Mailing Address - State:WA
Mailing Address - Zip Code:98625-9475
Mailing Address - Country:US
Mailing Address - Phone:360-953-7737
Mailing Address - Fax:
Practice Address - Street 1:415 CONFER RD
Practice Address - Street 2:
Practice Address - City:KALAMA
Practice Address - State:WA
Practice Address - Zip Code:98625-9475
Practice Address - Country:US
Practice Address - Phone:360-953-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60532010163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse