Healthcare Provider Details

I. General information

NPI: 1336833276
Provider Name (Legal Business Name): MARIA TERESA CARBO-GRUVER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 PENN ST
READING PA
19602-1108
US

IV. Provider business mailing address

310 KLINE ST
WEST READING PA
19611-1329
US

V. Phone/Fax

Practice location:
  • Phone: 610-988-4838
  • Fax: 855-547-2441
Mailing address:
  • Phone: 267-374-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP027666
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN740659
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: