Provider Demographics
NPI:1013243922
Name:GROENJES, KIM (APRN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:GROENJES
Suffix:
Gender:F
Credentials:APRN
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 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:402-717-4377
Mailing Address - Fax:
Practice Address - Street 1:3308 SAMSON WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3234
Practice Address - Country:US
Practice Address - Phone:402-717-7681
Practice Address - Fax:402-291-8806
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner