Healthcare Provider Details

I. General information

NPI: 1982879011
Provider Name (Legal Business Name): STACEY LANE GRUKA DNP, ARNP, CNM, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 WESTPORT AVE
NORWALK CT
06851-4310
US

IV. Provider business mailing address

1925 MOUNTAIN VIEW AVE
LONGMONT CO
80501-3128
US

V. Phone/Fax

Practice location:
  • Phone: 203-349-2950
  • Fax:
Mailing address:
  • Phone: 720-494-3130
  • Fax: 720-494-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0003341-C-CNM
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9246057
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number633
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9246057
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.0997369-CNM
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberC-APN.0003341-C-CNM
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: