Provider Demographics
NPI:1265058390
Name:GROUT, EMILY (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GROUT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 GRATIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-2215
Mailing Address - Country:US
Mailing Address - Phone:810-216-1200
Mailing Address - Fax:810-364-0698
Practice Address - Street 1:1985 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2215
Practice Address - Country:US
Practice Address - Phone:810-216-1200
Practice Address - Fax:810-364-0698
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner