Healthcare Provider Details

I. General information

NPI: 1861994626
Provider Name (Legal Business Name): JENNIFER GRUNE DNP FNP-BC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 09/04/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-590 OLD VOLCANO RD STE B
KEAAU HI
96749-8158
US

IV. Provider business mailing address

16-590 OLD VOLCANO RD STE B
KEAAU HI
96749-8158
US

V. Phone/Fax

Practice location:
  • Phone: 808-333-3450
  • Fax: 808-930-4721
Mailing address:
  • Phone: 808-333-3450
  • Fax: 808-930-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-2244
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER GRUNE
Title or Position: CEO/APRN
Credential: APRN
Phone: 808-333-3450