Provider Demographics
NPI:1093852055
Name:GROMOWSKI, PATRICK DAVID (RN)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:DAVID
Last Name:GROMOWSKI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6032 COUNTY ROAD PS
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9348
Mailing Address - Country:US
Mailing Address - Phone:262-629-9865
Mailing Address - Fax:
Practice Address - Street 1:N6032 COUNTY ROAD PS
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-9348
Practice Address - Country:US
Practice Address - Phone:262-629-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124172-30163W00000X
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39938900Medicaid