Healthcare Provider Details

I. General information

NPI: 1134045990
Provider Name (Legal Business Name): KATELYNN GRUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 41ST ST
DES MOINES IA
50310-3930
US

IV. Provider business mailing address

1804 41ST ST
DES MOINES IA
50310-3930
US

V. Phone/Fax

Practice location:
  • Phone: 515-985-9197
  • Fax: 515-985-9197
Mailing address:
  • Phone: 515-985-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: