Active NPI
Laurie A Van Grinsven, PA-C
- Physician Assistant
- Wautoma, WI
National Provider Identifier
1366446304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 938-023
- Practice address
- 400 S Townline Rd
Wautoma, WI 54982 - Phone
- (920) 787-5514
- Fax
- (920) 787-4737
- NPI assigned
- Jun 8, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 938-023 | WI | |
| Physician Assistant | 363A00000X | 938-023 | WI | Primary |
Addresses
Primary practice location
400 S Townline Rd
Wautoma, WI 54982
Mailing address
PO Box 1440
Wautoma, WI 54982-1440
Phone (920) 787-5514
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 521823 | Other | WI | MEDICARE PART A - CLINIC |
| 41971000 | Medicaid | WI | |
| 521824 | Other | WI | MEDICARE A MOBIL UNIT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534723200000",
"number": "1366446304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1440",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "549821440",
"telephone_number": "920-787-5514",
"fax_number": "920-787-4737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S TOWNLINE RD",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "54982",
"telephone_number": "920-787-5514",
"fax_number": "920-787-4737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN GRINSVEN",
"first_name": "LAURIE",
"middle_name": "A",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-08",
"last_updated": "2018-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WI",
"license": "938-023",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "938-023",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART A - CLINIC",
"identifier": "521823",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41971000",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE A MOBIL UNIT",
"identifier": "521824",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wautoma, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.