Provider Demographics
NPI:1750998837
Name:GRONEMAN, KYLA
Entity type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:
Last Name:GRONEMAN
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 1:8379 GARDENA HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8200
Mailing Address - Country:US
Mailing Address - Phone:702-490-1103
Mailing Address - Fax:
Practice Address - Street 1:8379 GARDENA HILLS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-8200
Practice Address - Country:US
Practice Address - Phone:702-490-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife