Basic Information
Provider Information
NPI: 1164482527
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GROEBNER
FirstName: RHONDA
MiddleName: LORRAINE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 43
Address2: MR 10809
City: MINNEAPOLIS
State: MN
PostalCode: 554400043
CountryCode: US
TelephoneNumber: 6122624813
FaxNumber: 6122624194
Practice Location
Address1: 800 E 28TH ST
Address2: SUITE H2100
City: MINNEAPOLIS
State: MN
PostalCode: 554073723
CountryCode: US
TelephoneNumber: 6127753030
FaxNumber: 6128631681
Other Information
ProviderEnumerationDate: 03/27/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XR126205-4MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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