Provider Demographics
NPI:1922402353
Name:GRONENTHAL, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GRONENTHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 ANGORA DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3758
Mailing Address - Country:US
Mailing Address - Phone:309-369-4894
Mailing Address - Fax:
Practice Address - Street 1:1558 ANGORA DRIVE
Practice Address - Street 2:
Practice Address - City:LOVLENAD
Practice Address - State:CO
Practice Address - Zip Code:80537-3758
Practice Address - Country:US
Practice Address - Phone:309-369-4894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991241363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care