Provider Demographics
NPI:1568718955
Name:GRONDIN, DANIEL JOSEPH (NREMT-B)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:GRONDIN
Suffix:
Gender:M
Credentials:NREMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LYSTER ARMY HEALTH CLINC
Mailing Address - Street 2:BLDG 301 ANDREWS AVE
Mailing Address - City:FT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7341
Mailing Address - Fax:334-255-7368
Practice Address - Street 1:LYSTER ARMY HEALTH CLINC
Practice Address - Street 2:BLDG 301 ANDREWS AVE
Practice Address - City:FT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7341
Practice Address - Fax:334-255-7368
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALB1623297146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic