Healthcare Provider Details

I. General information

NPI: 1982907259
Provider Name (Legal Business Name): STEPHANIE ELAINE GRUNER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2303
US

IV. Provider business mailing address

6621 FANNIN ST
HOUSTON TX
77030-2303
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1000
  • Fax:
Mailing address:
  • Phone: 832-824-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number727702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: