MEDICARE: MRS. JESSICA GRUBER N.D.

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	175F00000X	Naturopath	099.0134040	VT

General Provider Information

NPI Number	:	1679943591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA GRUBER N.D.

Provider Business Mailing Address
First Line	:	1309 HILL CREST RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-3233
Country	:	US
Telephone Number	:	513-214-1927
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 HILL CREST RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-3233
Country	:	US
Telephone Number	:	260-573-7098
Fax Number	:

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

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	08/21/2021

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