Provider Demographics
NPI:1548234404
Name:GROFF, DAWN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:GROFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 E BOSTON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6220
Mailing Address - Country:US
Mailing Address - Phone:804-448-2411
Mailing Address - Fax:480-476-8718
Practice Address - Street 1:1684 E BOSTON ST STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6220
Practice Address - Country:US
Practice Address - Phone:804-448-2411
Practice Address - Fax:480-476-8718
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0340363LW0102X
AZAP74244363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P63629Medicare UPIN
AZ73114Medicare ID - Type Unspecified