Provider Demographics
NPI:1992463376
Name:GROETKEN, ROBERT CECIL (PMHNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CECIL
Last Name:GROETKEN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 BRIDGEPORT WAY W
Mailing Address - Street 2:STE A #302
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4495
Mailing Address - Country:US
Mailing Address - Phone:206-251-1733
Mailing Address - Fax:
Practice Address - Street 1:4004 SUNSET DR W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-2405
Practice Address - Country:US
Practice Address - Phone:206-251-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61247918363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty