Individual
MARY ELIZABETH GROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.R.N., P.M.H.S.
Contact information
Practice address
59 LYME STREET, OLD LYME, CT 06371
(860) 373-6208
(860) 434-1580
Mailing address
P.O. BOX 589, 59 LYME STREET, OLD LYME, CT 06371
(860) 373-6208
(860) 434-1580
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
001632
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004200391
—
CT
Enumeration date
11/29/2005
Last updated
12/12/2017
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