Provider Demographics
NPI:1073405668
Name:GRONVOLD, MCKENZIE JO (FNP)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:JO
Last Name:GRONVOLD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:BRYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2975 HIGHWAY 2 E
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-7801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2975 HIGHWAY 2 E
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-7801
Practice Address - Country:US
Practice Address - Phone:701-776-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND202898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily