MEDICARE: MRS. KYLA GRONEMAN

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
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1750998837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KYLA GRONEMAN

Provider Business Mailing Address
First Line	:	8379 GARDENA HILLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-8200
Country	:	US
Telephone Number	:	702-490-1103
Fax Number	:

Provider Business Practice Location Address
First Line	:	8379 GARDENA HILLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-8200
Country	:	US
Telephone Number	:	702-490-1103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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Directions to “ MRS. KYLA GRONEMAN ” Practice Location

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