Provider Demographics
NPI:1326005331
Name:GROTH, CAROL L (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:GROTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:737 E CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5103
Mailing Address - Country:US
Mailing Address - Phone:785-827-7261
Mailing Address - Fax:785-827-6334
Practice Address - Street 1:511 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4145
Practice Address - Country:US
Practice Address - Phone:785-827-7261
Practice Address - Fax:785-827-6334
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74317363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161173Medicare PIN