MEDICARE: JANELLE MARIE GRUENBERG A-GNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	4704318567	MI

General Provider Information

NPI Number	:	1366127029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE MARIE GRUENBERG A-GNP-C

Provider Business Mailing Address
First Line	:	7571 COUNTRYSIDE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-9501
Country	:	US
Telephone Number	:	989-572-8348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 E BELLOWS ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3872
Country	:	US
Telephone Number	:	989-953-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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