Provider Demographics
NPI:1861978421
Name:GROTHUSEN, CELESTE DELAINE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:DELAINE
Last Name:GROTHUSEN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 N RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1210
Mailing Address - Country:US
Mailing Address - Phone:316-269-3223
Mailing Address - Fax:316-269-3328
Practice Address - Street 1:3510 N RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1210
Practice Address - Country:US
Practice Address - Phone:316-269-3223
Practice Address - Fax:316-269-3328
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78246363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily