Basic Information
| Provider Information | |||||||||
| NPI: | 1285755587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSSENBURG | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053286585 | ||||||||
| FaxNumber: | 6053286512 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 W 22ND ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053287700 | ||||||||
| FaxNumber: | 6053287775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25696 | NE | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | N7270 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 8833 | SD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.