Provider Demographics
NPI:1659260636
Name:GROENEWEG, KATHERINE (RN BSN PHN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GROENEWEG
Suffix:
Gender:F
Credentials:RN BSN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-3920
Mailing Address - Country:US
Mailing Address - Phone:507-379-5530
Mailing Address - Fax:
Practice Address - Street 1:2115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-3920
Practice Address - Country:US
Practice Address - Phone:507-379-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1915262163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice