Provider Demographics
NPI:1851361216
Name:GROMER, LAURIE C (CNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:C
Last Name:GROMER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:C
Other - Last Name:KNUTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:605-339-0309
Practice Address - Street 1:1309 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4663
Practice Address - Country:US
Practice Address - Phone:605-328-8000
Practice Address - Fax:605-328-8001
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6828010Medicaid
SD2380598OtherAMERICAS PPO
MN448690100Medicaid
SD4994407OtherBLUE CROSS
SD100634Medicare PIN
SD4994407OtherBLUE CROSS