Healthcare Provider Details

I. General information

NPI: 1679943591
Provider Name (Legal Business Name): JESSICA GRUBER N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 HILL CREST RD
CINCINNATI OH
45224-3233
US

IV. Provider business mailing address

1309 HILL CREST RD
CINCINNATI OH
45224-3233
US

V. Phone/Fax

Practice location:
  • Phone: 260-573-7098
  • Fax:
Mailing address:
  • Phone: 513-214-1927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0134040
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: