Individual
KYLE DOUGLAS GRONBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1423 N JEFFERSON AVE, SPRINGFIELD, MO 65802-1917
(000) 000-0000
Mailing address
PO BOX 505673, SAINT LOUIS, MO 63150-5673
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2022040333
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200117832
—
MO
Enumeration date
10/07/2022
Last updated
04/09/2024
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