Avis L Grothem, FNP/CNM

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

R29668 Issued in ND

Practice address

306 4TH St N
Fargo, ND 58102-4820

Phone

(701) 239-7111

NPI assigned

Nov 3, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of North Dakota

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1952969099
  NPD (past)
• Family Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Moorhead, MN
  • NPI 1992559645
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841379401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2625",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581082625",
            "telephone_number": "701-239-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 4TH ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024820",
            "telephone_number": "701-239-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROTHEM",
        "first_name": "AVIS",
        "middle_name": "L",
        "credential": "FNP/CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "ND",
            "license": "R29668",
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "MN",
            "license": "R0772147",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19747",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "527465600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carla Andrea Grossoli, M.D.
• David E Grosz, M.D.
• Kenneth Daniel Grosz, M.D.
• Bonnie L Groth, NP
• Melissa Groth
• Pam Grothman, RN
• Jill Marie Grotluschen, L.S.W
• Chelsea Lynn Grove, LSW
• Katrina Grove, LMSW
• Growth Mindset Counseling

• Obstetrics & Gynecology Nurse Practitioner in Fargo, ND
• Providers in Fargo, ND by specialty
• Obstetrics & Gynecology Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.