Provider Demographics
NPI:1417843012
Name:GROTELUSCHEN, CHANTELL MARIE
Entity type:Individual
Prefix:
First Name:CHANTELL
Middle Name:MARIE
Last Name:GROTELUSCHEN
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:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:NE
Mailing Address - Zip Code:68634-0056
Mailing Address - Country:US
Mailing Address - Phone:402-679-5464
Mailing Address - Fax:
Practice Address - Street 1:17022 280TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-6387
Practice Address - Country:US
Practice Address - Phone:402-910-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider