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NPI Code Detail

MEDICARE: LISA C GRONBERG PA-C

MEDICARE: LISA C GRONBERG PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1793TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215255591
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA C GRONBERG PA-C
Provider Business Mailing Address
First Line : 222 22ND AVE N
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-1852
Country : US
Telephone Number : 629-255-3486
Fax Number :
Provider Business Practice Location Address
First Line : 325 OLD PLEASANT GROVE RD
Second Line :
City : MOUNT JULIET
State : TN
Zip : 37122-4493
Country : US
Telephone Number : 629-255-2134
Fax Number : 629-255-4156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2010
Last Update Date : 12/20/2024

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Directions to “ LISA C GRONBERG PA-C” Practice Location

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