Individual
SANDRA R VAN GROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
5300 MEMORIAL DR, TWO RIVERS, WI 54241-3923
(920) 793-7337
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(920) 793-7337
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7927
WI
363LP0200X
Pediatric Nurse Practitioner
7927
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071520
—
WI
Enumeration date
08/23/2017
Last updated
08/28/2024
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