Individual
SARA MARIE GROTEFENDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6810 STATE ROUTE 162 STE 105, MARYVILLE, IL 62062-8560
(618) 288-9320
(618) 288-9258
Mailing address
6810 STATE ROUTE 162, BOX 215, MARYVILLE, IL 62062
(618) 391-6495
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
209017373
IL
Other
Enumeration date
01/21/2019
Last updated
08/28/2024
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