Individual provider · Type 1 NPI
Mary Elizabeth Groth, A.P.R.N., P.M.H.S.
Pediatric Nurse Practitioner · Old Lyme, CT
NPI number
1508849076
Active
Practice location
59 Lyme Street
Old Lyme, CT 06371
Fax (860) 434-1580
Mailing address
P.o. Box 589, 59 Lyme Street
Old Lyme, CT 06371
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner Primary | 363LP0200X | 001632 (CT) |
Pediatric Nurse Practitioner: Definition to come...
About NPI 1508849076
Mary Elizabeth Groth, A.P.R.N., P.M.H.S.'s National Provider Identifier is 1508849076, issued on Nov 29, 2005. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Old Lyme, CT. The record was last updated on Dec 12, 2017.