Provider Demographics
NPI:1245955848
Name:GROTHAUSE, DOMONIQUE JADE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:DOMONIQUE
Middle Name:JADE
Last Name:GROTHAUSE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:340 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7971
Mailing Address - Country:US
Mailing Address - Phone:614-545-7900
Mailing Address - Fax:614-545-7901
Practice Address - Street 1:340 POLARIS PKWY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7971
Practice Address - Country:US
Practice Address - Phone:614-839-2300
Practice Address - Fax:614-839-2301
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2025-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50.007865RX363A00000X
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant