Provider Demographics
NPI:1003833591
Name:GRONEWALD, DEBORAH A (RN, MSN, NP, CDE)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:GRONEWALD
Suffix:
Gender:F
Credentials:RN, MSN, NP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5812
Mailing Address - Country:US
Mailing Address - Phone:423-581-4618
Mailing Address - Fax:423-317-9428
Practice Address - Street 1:751 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-5812
Practice Address - Country:US
Practice Address - Phone:423-581-4618
Practice Address - Fax:423-317-9428
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005219363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P08045Medicare UPIN