Individual
MS. MICHELE M. GRUENENFELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
515 22ND AVE., MONROE, WI 53566-1569
(608) 263-1530
Mailing address
515 22ND AVE., MONROE, WI 53566-1569
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1609
WI
363AM0700X
Medical Physician Assistant
1609-023
WI
363AS0400X
Surgical Physician Assistant
1609-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558319848
—
WI
Enumeration date
05/05/2006
Last updated
11/18/2020
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