Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 2278 | MN |
NPI | 1881853836 |
---|---|
Provider Name | Dr. Theresa Joan Gromala |
First Address | Bloomington, MN 55431-2007 |
Second Address | Bloomington, MN 55431-2007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 05/06/2008 |