Provider Demographics
NPI:1740873967
Name:GRONEWOLD, JOANNE KAY (FNP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:KAY
Last Name:GRONEWOLD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 PINE DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4214
Mailing Address - Country:US
Mailing Address - Phone:575-415-1019
Mailing Address - Fax:
Practice Address - Street 1:2318 PINE DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4214
Practice Address - Country:US
Practice Address - Phone:575-415-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM58109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty