| Doctor Name: | LAURIE A VAN GRINSVEN |
| NPI Number: | 1366446304 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 938-023 |
| Business Practice Address: | 400 S Townline Rd Wautoma, WI - 549821440 |
| Business Phone Number: | 9207875514 |
| Business Fax Number: | 9207874737 |
| Mailing Address: | Po Box 1440, WAUTOMA |
| State: | WI |
| Postal Code: | 549821440 |
| Phone Number: | 9207875514 |
| Fax Number: | 9207874737 |
| NPI Enumeration Date: | 06/08/2005 |
| NPI Last Update Date: | 08/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 938-023 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |