Provider Demographics
NPI:1912374141
Name:GRONEWOLD, RHIAN (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:RHIAN
Middle Name:
Last Name:GRONEWOLD
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5200
Mailing Address - Country:US
Mailing Address - Phone:319-236-3444
Mailing Address - Fax:319-236-0257
Practice Address - Street 1:3812 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5200
Practice Address - Country:US
Practice Address - Phone:319-236-3444
Practice Address - Fax:319-236-0257
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA135130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1912374141OtherNPI
1629032404OtherEMPLOYER (BUSINESS) NPI