Healthcare Provider Details

I. General information

NPI: 1851361216
Provider Name (Legal Business Name): LAURIE C. GROMER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE C. KNUTSON CNP

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 05/21/2022
Certification Date: 05/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W 17TH ST
SIOUX FALLS SD
57104-4663
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8000
  • Fax: 605-328-8001
Mailing address:
  • Phone:
  • Fax: 605-339-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP000445
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: