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General NPI Number Information
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NPI Number | 1205875911
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Entity Type | Individual
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Provider Name | MARK A. GRUBER CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 12/21/2019
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Provider Practice Location Address
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Address Line | 3500 ARENDELL ST
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City | MOREHEAD CITY
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State | NC
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Zip | 28557-2901
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Country | US
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Telephone | 252-499-6000
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Fax | 252-808-6938
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Provider Business Mailing Address
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Address Line | 404 EASTLEY CT APT 2
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City | KINGSPORT
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State | TN
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Zip | 37660-6411
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Country | US
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Telephone | 803-479-2372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN197129L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 74148
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 157903
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License Number State | NC
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