Healthcare Provider Details

I. General information

NPI: 1528160363
Provider Name (Legal Business Name): RENATA G GRUBER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 5TH AVE STE 300
SPOKANE WA
99204-2972
US

IV. Provider business mailing address

400 E 5TH AVE
SPOKANE WA
99202-1334
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax:
Mailing address:
  • Phone: 509-838-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30003154W
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30003154W
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: