Provider Demographics
NPI:1861046567
Name:GROCHOWSKI, REBECCA WHITLOCK (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:WHITLOCK
Last Name:GROCHOWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:WHITLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 SAINT PAUL PL DEPT OF
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2165
Mailing Address - Country:US
Mailing Address - Phone:410-783-5858
Mailing Address - Fax:410-783-5864
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:DEPT OF MED
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2165
Practice Address - Country:US
Practice Address - Phone:410-332-9407
Practice Address - Fax:410-332-9789
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211857363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology