Provider Demographics
NPI:1447651708
Name:GROSCH, DANA M (FNP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:GROSCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:200 ADMIRAL TROST RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2164
Mailing Address - Country:US
Mailing Address - Phone:618-281-7373
Mailing Address - Fax:
Practice Address - Street 1:200 ADMIRAL TROST RD STE 1A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2164
Practice Address - Country:US
Practice Address - Phone:618-281-7373
Practice Address - Fax:618-281-6463
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011774363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner