Provider Demographics
NPI:1376628636
Name:GROETHE, EMMA JANE (CNP, MSN)
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:JANE
Last Name:GROETHE
Suffix:
Gender:F
Credentials:CNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 CARLSFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1173
Mailing Address - Country:US
Mailing Address - Phone:216-288-4004
Mailing Address - Fax:330-678-3501
Practice Address - Street 1:9302 OLDE 8 RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2027
Practice Address - Country:US
Practice Address - Phone:330-468-1661
Practice Address - Fax:330-908-1145
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133665363LF0000X
OH09173363LF0000X
OHRN133665364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01249OtherCNS OHIO COA
2006007685-21OtherNP CERTIFICATION
OH2594296Medicaid
OHNP-09173OtherCERTIFICED NURSE PRACTITI
GRNS01136Medicare UPIN
OH01249OtherCNS OHIO COA