Provider Demographics
NPI:1730524992
Name:GRONSKI, JEANETTE (LPN)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:GRONSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1234
Mailing Address - Country:US
Mailing Address - Phone:570-457-7804
Mailing Address - Fax:
Practice Address - Street 1:714 EDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1234
Practice Address - Country:US
Practice Address - Phone:570-457-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN096207L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse