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General NPI Number Information
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NPI Number | 1285232801
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Entity Type | Individual
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Provider Name | LESLIE KENNETH GRONOS
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Gender | Male
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | RAMONA GRONOS 7291 41ST AVE NE
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City | RUGBY
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State | ND
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Zip | 58368-7604
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Country | US
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Telephone | 701-583-2353
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Fax |
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Provider Business Mailing Address
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Address Line | 7291 41ST AVE NE
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City | RUGBY
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State | ND
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Zip | 58368-7604
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Country | US
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Telephone | 701-509-4821
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 1451970
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License Number State |
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