Healthcare Provider Details

I. General information

NPI: 1992136212
Provider Name (Legal Business Name): CHRISTINE GRONVALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SAINT VINCENTS DR POB 3 SUITE 402
BIRMINGHAM AL
35205-1606
US

IV. Provider business mailing address

833 SAINT VINCENTS DR POB 3 SUITE 402
BIRMINGHAM AL
35205-1606
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-9236
  • Fax: 205-933-9213
Mailing address:
  • Phone: 205-933-9236
  • Fax: 205-933-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1117A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: