Provider Demographics
NPI:1932949252
Name:GROGG, ASHLEY (MSN-RN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GROGG
Suffix:
Gender:F
Credentials:MSN-RN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:HISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 9185
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46899-9185
Mailing Address - Country:US
Mailing Address - Phone:260-286-0028
Mailing Address - Fax:
Practice Address - Street 1:1910 BUCKSKIN DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1313
Practice Address - Country:US
Practice Address - Phone:260-286-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28170204C163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse