Individual
BONNIE L GROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2251
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2251
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R30800
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84048
—
ND
Enumeration date
01/13/2011
Last updated
03/05/2013
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