AVIS L GROTHEM (NPI# 1841379401) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841379401 |
| Entity Type | Individual |
| Full Name | AVIS L GROTHEM |
| Credential | FNP/CNM |
| Practice Address |
306 4th St N Fargo ND 58102-4820 |
| Mailing Address |
Po Box 2625 Fargo ND 58108-2625 |
| Practice Telephone | 7012397111 |
| Mailing Telephone | 7012397111 |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LX0001X |
Nurse Practitioner Specialization: Obstetrics & Gynecology |
R0772147 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LX0001X |
Nurse Practitioner Specialization: Obstetrics & Gynecology |
R29668 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 19747 | 05 | |
| MN | 527465600 | 05 |
| Street Address |
306 4TH ST N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-4820 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437153905 | Jay R Metzger | Physician Assistant | 306 4th St N, Fargo, ND 58102-4820 | 2005-06-13 |
| 1174893879 | Jill Mcmullen | Nurse Practitioner | 306 4th St N, Fargo, ND 58102-4820 | 2012-01-11 |
| 1134431729 | Andrea Lynn Wilson | Dentist | 306 4th St N, Fargo, ND 58102-4820 | 2010-07-12 |
| 1861637852 | Randy C Swingen | Nurse Practitioner | 306 4th St N, Fargo, ND 58102-4820 | 2008-12-05 |
| 1619137551 | Joanna Brekhus | Dentist | 306 4th St N, Fargo, ND 58102-4820 | 2008-06-13 |
| 1437353406 | Lacee Janelle Steinberger | Nurse Practitioner | 306 4th St N, Fargo, ND 58102-4820 | 2007-06-13 |
| 1336366798 | Bonnie Anderson | Nurse Practitioner | 306 4th St N, Fargo, ND 58102-4820 | 2007-04-19 |
| 1407921919 | Robert E Hackley Jr. | Dentist | 306 4th St N, Fargo, ND 58102-4820 | 2006-11-21 |
| 1053480277 | William Savage | Dentist | 306 4th St N, Fargo, ND 58102-4820 | 2006-11-06 |
| 1942379060 | Terrence L Johnson | Dentist | 306 4th St N, Fargo, ND 58102-4820 | 2006-11-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 363LX0001X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Obstetrics & Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275001992 | Heidi Selzler-echola | Nurse Practitioner | 100 4th St S Ste 608, Fargo, ND 58103-1940 | 2018-11-12 |
| 1578127080 | Desiree Froslie | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2019-04-30 |
| 1467948455 | Allison Harrison | Nurse Practitioner | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2018-07-03 |
| 1215287495 | Cheri B Cross | Nurse Practitioner | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2012-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760468078 | Therese Mcmahan | Nurse Practitioner | 1300 Hospital Loop, Belcourt, ND 58316-0160 | 2005-12-19 |
| 1144784000 | Kayla Marie Benz | Nurse Practitioner | 414 N 7th St, Bismarck, ND 58501-4423 | 2019-01-24 |
| 1285899138 | Kendra Leigh Roloff | Nurse Practitioner | 401 N 9th St, Bismarck, ND 58501-4530 | 2008-07-21 |
Please comment or provide details below to improve the information on AVIS L GROTHEM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.