Van Grinsven, Laurie A

Van Grinsven, Laurie A is an individual health care provider with primary practice located at 400 S Townline Rd , Wautoma WI 54982. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Van Grinsven, Laurie A can be contacted via phone (920) 787-5514.

Contact Information

Primary practice address
400 S Townline Rd Wautoma WI 54982
Phone: (920) 787-5514
Fax: (920) 787-4737
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 938-023 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 938-023 Wisconsin

Profile Details

NPI number 1366446304
LBN Legal business name Van Grinsven, Laurie A
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2005
Last updated Aug 20th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366446304 NPPES
Wisconsin Other 521823 MEDICARE PART A - CLINIC
Wisconsin MEDICAID 41971000 MEDICARE PART A - CLINIC
Wisconsin Other 521824 MEDICARE PART A - CLINIC

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