Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APN0000005219 | TN |
NPI | 1003833591 |
---|---|
Provider Name | Deborah A Gronewald |
First Address | Morristown, TN 37813-5812 |
Second Address | Morristown, TN 37813-5812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P08045 | (02) |