Provider Demographics
NPI:1508255134
Name:GROENEVELD, JOHN L (ARNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:GROENEVELD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NW 114TH ST
Mailing Address - Street 2:STE 347
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7046
Mailing Address - Country:US
Mailing Address - Phone:515-224-1777
Mailing Address - Fax:515-225-6750
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:STE 347
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-7046
Practice Address - Country:US
Practice Address - Phone:515-224-1777
Practice Address - Fax:515-225-6750
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA107375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner