Provider Demographics
NPI:1043604507
Name:GRUNTHANER, DEBORAH (RN,BSN,CDE)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GRUNTHANER
Suffix:
Gender:F
Credentials:RN,BSN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 W CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3314
Mailing Address - Country:US
Mailing Address - Phone:814-335-4362
Mailing Address - Fax:
Practice Address - Street 1:1200 WOOD ST
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:PA
Practice Address - Zip Code:15824-2118
Practice Address - Country:US
Practice Address - Phone:814-265-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN525183L163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator