Provider Demographics
NPI:1447225958
Name:GROTHAUS, KAY L (APRN CNS)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:L
Last Name:GROTHAUS
Suffix:
Gender:F
Credentials:APRN CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 N MCCORD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1701
Mailing Address - Country:US
Mailing Address - Phone:419-517-1110
Mailing Address - Fax:419-517-1108
Practice Address - Street 1:3020 N MCCORD RD STE 102
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1701
Practice Address - Country:US
Practice Address - Phone:419-517-1110
Practice Address - Fax:419-517-1108
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-18
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 21-15-7150163WP0808X
OHAPRNCNS01900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNS02361Medicare ID - Type Unspecified
OHP81375Medicare UPIN