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General NPI Number Information
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NPI Number | 1386338747
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Entity Type | Individual
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Provider Name | KELLI GRUSS CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | UNIT 5024
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City | APO
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State | AP
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Zip | 96319-5024
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Country | US
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Telephone | 315-226-6458
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 5024
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City | APO
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State | AP
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Zip | 96319-5024
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Country | US
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Telephone | 315-226-6458
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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 | 0020818
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License Number State | OH
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