Laurie A Van Grinsven, PA-C

NPI #1366446304 in Wautoma, Wisconsin

Provider Information

NPI Number: 1366446304
Entity Type: Individual
Name: Laurie A Van Grinsven, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Jun 8, 2005
Last Updated: Aug 20, 2018

Practice Location

Address: 400 S TOWNLINE RD
City: Wautoma
State: Wisconsin
ZIP Code: 54982
Phone: (920) 787-5514

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant - Medical — Medical	363AM0700X
Physician Assistant	363A00000X	Primary

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