MEDICARE: JACQUELYN GRUER CNM

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	367A00000X	Advanced Practice Midwife	RN-187380/NM01412	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201488810028	OTHER	OH	CARESOURCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	109026341696	OTHER	OH	HUMANA

General Provider Information

NPI Number	:	1457352585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN GRUER CNM

Provider Business Mailing Address
First Line	:	4342 HAIGHT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-1749
Country	:	US
Telephone Number	:	513-542-8259
Fax Number	:

Provider Business Practice Location Address
First Line	:	4244 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-2048
Country	:	US
Telephone Number	:	513-681-4900
Fax Number	:	513-853-8432

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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