Provider Demographics
NPI:1881959559
Name:GROTHAUSE, JENNIFER LYNN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:GROTHAUSE
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 1:1401 BROADVIEW AVE
Mailing Address - Street 2:APARTMENT 11
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2846
Mailing Address - Country:US
Mailing Address - Phone:614-565-4788
Mailing Address - Fax:
Practice Address - Street 1:1401 BROADVIEW AVE
Practice Address - Street 2:APARTMENT 11
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2846
Practice Address - Country:US
Practice Address - Phone:614-565-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.379980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse