Healthcare Provider Details

I. General information

NPI: 1790861771
Provider Name (Legal Business Name): PATRICIA FINK GRONCKI-MENINGER MS, CPNP, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA FINK GRONCKI-REICHERT MS, CPNP, CFNP

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 FRANKLIN SQUARE DR
ROSEDALE MD
21237-3903
US

IV. Provider business mailing address

2822 ONYX RD
BALTIMORE MD
21234-5639
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-6452
  • Fax:
Mailing address:
  • Phone: 410-661-3677
  • Fax: 410-661-3684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343880-22
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0023100-06
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: