Individual
ROBERT J GROENEWOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 E 21ST ST, SIOUX FALLS, SD 57105-1016
(605) 322-2754
(605) 322-2727
Mailing address
800 E 21ST ST, SIOUX FALLS, SD 57105-1016
(605) 322-2754
(605) 322-2727
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R026334 - 0461
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006659
SD BLUE CROSS
SD
01
—
051K0GR
MN BLUE CROSS
MN
05
—
0573980
—
IA
05
—
460224743-48
—
NE
01
—
460224743-57105-AC41
TRICARE PROVIDER #
SD
05
—
5753700
—
SD
01
—
R026334
DAKOTACARE PROVIDER #
SD
Enumeration date
08/11/2006
Last updated
03/06/2008
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