Healthcare Provider Details

I. General information

NPI: 1780801746
Provider Name (Legal Business Name): MICHELLE L GRUENSTERN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE L HOPPA

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N MEADE ST SUITE 240 WEST
APPLETON WI
54911-3496
US

IV. Provider business mailing address

1818 N MEADE ST SUITE 240 WEST
APPLETON WI
54911-3496
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-8131
  • Fax:
Mailing address:
  • Phone: 920-731-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number170302-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: