Provider Demographics
NPI:1336304823
Name:GROLL, KATHRYN GILES (CNM, PMHNP-BC, DNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GILES
Last Name:GROLL
Suffix:
Gender:F
Credentials:CNM, PMHNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-1931
Mailing Address - Country:US
Mailing Address - Phone:908-276-2706
Mailing Address - Fax:
Practice Address - Street 1:22 HILL RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1078
Practice Address - Country:US
Practice Address - Phone:973-335-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ1481100363LP0808X
NJ25ME00042801367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife