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General NPI Number Information
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NPI Number | 1306472782
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Entity Type | Individual
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Provider Name | MARY JOYCE GRUBER CNS
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Gender | Female
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 45 10TH ST W FL 41514
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City | SAINT PAUL
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State | MN
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Zip | 55102-1062
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Country | US
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Telephone | 651-232-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 45 10TH ST W FL 4151
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City | SAINT PAUL
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State | MN
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Zip | 55102-1062
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Country | US
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Telephone | 651-232-3340
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 119
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License Number State | MN
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