NPI Code Detail JSON Logo

1073405668 NPI number — MCKENZIE JO GRONVOLD FNP

NPI Number: 1073405668
Health Care Provider/Practitioner: MCKENZIE JO GRONVOLD FNP

Information about “1073405668” NPI (MCKENZIE JO GRONVOLD FNP) exists in 1073405668 in HTML format HTML  |  1073405668 in plain Text format TXT  |  1073405668 in PDF (Portable Document Format) PDF  |  1073405668 in an XML format XML  formats.

NPI Number : 1073405668 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073405668",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRONVOLD",
    "FirstName": "MCKENZIE",
    "MiddleName": "JO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRYN",
    "OtherFirstName": "MCKENZIE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2975 HIGHWAY 2 E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RUGBY",
    "MailingAddressStateName": "ND",
    "MailingAddressPostalCode": "58368-7801",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2975 HIGHWAY 2 E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RUGBY",
    "PracticeLocationAddressStateName": "ND",
    "PracticeLocationAddressPostalCode": "58368-7801",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "701-776-7000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/17/2025",
    "LastUpdateDate": "07/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "202898",
        "LicenseNumberStateCode": "ND",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.