Healthcare Provider Details

I. General information

NPI: 1528170982
Provider Name (Legal Business Name): BONNIE L GROESSL MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 VELP AVE SUITE 205
GREEN BAY WI
54303-5424
US

IV. Provider business mailing address

2987 DURHAM RD
GREEN BAY WI
54311-7296
US

V. Phone/Fax

Practice location:
  • Phone: 920-434-8500
  • Fax: 920-468-9791
Mailing address:
  • Phone: 920-468-9315
  • Fax: 920-468-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number79614
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: