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General NPI Number Information
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NPI Number | 1093367799
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Entity Type | Individual
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Provider Name | JOSALYN J GRUENEICH APRN,CNP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1401 13TH AVE E
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City | WEST FARGO
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State | ND
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Zip | 58078-3468
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Country | US
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Telephone | 701-364-0060
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Fax | 701-364-0065
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Provider Business Mailing Address
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Address Line | 1702 UNIVERSITY DR S
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City | FARGO
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State | ND
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Zip | 58103-4940
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R35104
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R35104
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License Number State | ND
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