Provider Demographics
NPI:1285232801
Name:GRONOS, LESLIE KENNETH
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:KENNETH
Last Name:GRONOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7291 41ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-7604
Mailing Address - Country:US
Mailing Address - Phone:701-509-4821
Mailing Address - Fax:
Practice Address - Street 1:RAMONA GRONOS
Practice Address - Street 2:7291 41ST AVE NE
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-7604
Practice Address - Country:US
Practice Address - Phone:701-583-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14519703747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant