Healthcare Provider Details

I. General information

NPI: 1831547611
Provider Name (Legal Business Name): CHRISTOPHER GRUBER MNA, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RIVERBANK AVE
DANVERS MA
01923-3208
US

IV. Provider business mailing address

7 RIVERBANK AVE
DANVERS MA
01923-3208
US

V. Phone/Fax

Practice location:
  • Phone: 512-350-6883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP141751
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number123407
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: