Healthcare Provider Details

I. General information

NPI: 1174449722
Provider Name (Legal Business Name): MIA CHARMIAN GRULER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PIERCE ST
KINGSTON PA
18704-5532
US

IV. Provider business mailing address

930 MEADOW AVE APT 104
SCRANTON PA
18505-2575
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-3535
  • Fax:
Mailing address:
  • Phone: 480-563-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: