Individual
SANDRA K GRONINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
714 N SENATE AVE, STE 100, INDIANAPOLIS, IN 46202-3763
(317) 715-6402
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001030
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000550586
BCBS PIN
IN
05
—
200879020
—
IN
01
—
P01131006
RAILROAD MEDICARE
IN
Enumeration date
07/27/2007
Last updated
01/28/2021
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