Provider Demographics
NPI:1194232108
Name:GREG KRONENBERG CRNA, LLC
Entity type:Organization
Organization Name:GREG KRONENBERG CRNA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KRONENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:775-750-9502
Mailing Address - Street 1:1360 NE 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6695
Mailing Address - Country:US
Mailing Address - Phone:775-750-9502
Mailing Address - Fax:
Practice Address - Street 1:800 E 1ST ST STE E230
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2110
Practice Address - Country:US
Practice Address - Phone:775-750-9502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD145432367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty