Provider Demographics
NPI:1265679344
Name:GROSINSKE, LENORE MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:LENORE
Middle Name:MARIE
Last Name:GROSINSKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 S 57TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-8961
Mailing Address - Country:US
Mailing Address - Phone:715-848-5112
Mailing Address - Fax:
Practice Address - Street 1:1103 S 57TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-8961
Practice Address - Country:US
Practice Address - Phone:715-848-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI145165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38323800Medicaid