Provider Demographics
NPI:1912176280
Name:GROTEFENDT, MADELINE LYNNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:LYNNE
Last Name:GROTEFENDT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1949 GUNBARREL ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-296-0556
Mailing Address - Fax:
Practice Address - Street 1:6401 MOUNTAIN VIEW ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363
Practice Address - Country:US
Practice Address - Phone:423-495-5951
Practice Address - Fax:423-495-5999
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN74644363LF0000X
TN6184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily