Healthcare Provider Details

I. General information

NPI: 1457352585
Provider Name (Legal Business Name): JACQUELYN GRUER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 HAMILTON AVE
CINCINNATI OH
45223-2048
US

IV. Provider business mailing address

4342 HAIGHT AVE
CINCINNATI OH
45223-1749
US

V. Phone/Fax

Practice location:
  • Phone: 513-681-4900
  • Fax: 513-853-8432
Mailing address:
  • Phone: 513-542-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN-187380/NM01412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: