Healthcare Provider Details

I. General information

NPI: 1740509454
Provider Name (Legal Business Name): ELLEN M GRONSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 OLIVER ST
AVOCA NY
14809-9605
US

IV. Provider business mailing address

8 OLIVER ST
AVOCA NY
14809-9605
US

V. Phone/Fax

Practice location:
  • Phone: 607-566-2820
  • Fax:
Mailing address:
  • Phone: 607-566-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: