MEDICARE: KAREN J GRUBER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R0867434	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679672661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN J GRUBER CRNA

Provider Business Mailing Address
First Line	:	1519 BROKEN OAK CT
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55038-9603
Country	:	US
Telephone Number	:	651-402-9328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1519 BROKEN OAK COURT
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55038-9603
Country	:	US
Telephone Number	:	651-402-9328
Fax Number	:

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	12/13/2016

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