Provider Demographics
NPI:1295446714
Name:GROSHEK, NICOLE APRIL
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:APRIL
Last Name:GROSHEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 WESTERN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1531
Mailing Address - Country:US
Mailing Address - Phone:715-432-2114
Mailing Address - Fax:
Practice Address - Street 1:1020 WESTERN AVE STE C
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1531
Practice Address - Country:US
Practice Address - Phone:715-432-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI-Medicaid