Laurie A Van Grinsven, PA-C is a
Physician Assistant based in Wautoma, Wisconsin. Laurie A Van Grinsven is licensed to practice in Wisconsin (license number 938-023) and her current practice location is
400 S Townline Rd, Wautoma, Wisconsin. She can be reached at her office (for appointments etc.) via phone at
(920) 787-5514.
NPI number for Laurie A Van Grinsven is 1366446304 and her current mailing address is Po Box 1440, Wautoma, Wisconsin. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1366446304.
Provider's Profile
| Full Name | Laurie A Van Grinsven |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Location | 400 S Townline Rd, Wautoma, Wisconsin |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1366446304
- Provider Enumeration Date: 06/08/2005
- Last Update Date: 08/20/2018
Medical Identifiers
Medical identifiers for Laurie A Van Grinsven such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1366446304 | NPI | - | NPPES |
| 521823 | Other | WI | MEDICARE PART A - CLINIC |
| 41971000 | Medicaid | WI | |
| 521824 | Other | WI | MEDICARE A MOBIL UNIT |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363AM0700X | Physician Assistant - Medical | 938-023 (Wisconsin) | Secondary |
| 363A00000X | Physician Assistant | 938-023 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Laurie A Van Grinsven is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Laurie A Van Grinsven, PA-C
Po Box 1440,
Wautoma, WI 54982-1440
Ph: (920) 787-5514 | Laurie A Van Grinsven, PA-C
400 S Townline Rd,
Wautoma, WI 54982
Ph: (920) 787-5514 |
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