Provider Demographics
NPI:1730548488
Name:GROODY, EVONNE (RN, BSN, CCRN)
Entity type:Individual
Prefix:
First Name:EVONNE
Middle Name:
Last Name:GROODY
Suffix:
Gender:F
Credentials:RN, BSN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17967-9409
Mailing Address - Country:US
Mailing Address - Phone:570-590-9045
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:610-834-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA#RN607901163W00000X, 163WC0200X, 163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience