Individual
MRS. TINA MARIE DEGROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
900 RIDGE ST, STOUGHTON, WI 53589-1864
(608) 873-6611
Mailing address
900 RIDGE ST, STOUGHTON, WI 53589-1864
(608) 873-6611
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
3554-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38219400
—
WI
Enumeration date
11/01/2006
Last updated
10/02/2024
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