Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2019079039 | WI |
NPI | 1003442849 |
---|---|
Provider Name | Jurgita Gronkowski |
First Address | Milwaukee, WI 53295-0001 |
Second Address | Milwaukee, WI 53295-2247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2020 |
Last Update Date | 06/04/2020 |