Provider Demographics
NPI:1598146706
Name:GROTHAUS, THRESA LYNN (MS, APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:THRESA
Middle Name:LYNN
Last Name:GROTHAUS
Suffix:
Gender:F
Credentials:MS, APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-1601
Mailing Address - Country:US
Mailing Address - Phone:567-765-1111
Mailing Address - Fax:833-940-3627
Practice Address - Street 1:152 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-1601
Practice Address - Country:US
Practice Address - Phone:567-765-1111
Practice Address - Fax:833-940-3627
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN246505363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0133929Medicaid