Provider Demographics
NPI:1881675049
Name:GROESCHKE, ANITA L (CNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:L
Last Name:GROESCHKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:L
Other - Last Name:WARD AND GAWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9345 SUSSEX DR
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-2613
Mailing Address - Country:US
Mailing Address - Phone:440-503-4209
Mailing Address - Fax:440-888-0523
Practice Address - Street 1:9345 SUSSEX DR
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-2613
Practice Address - Country:US
Practice Address - Phone:440-503-4209
Practice Address - Fax:440-888-0523
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-03609363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S66794Medicare UPIN