Provider Demographics
NPI:1093902215
Name:GRUNER, MICHELE L (DNP, APN)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:GRUNER
Suffix:
Gender:F
Credentials:DNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 HARBOR BLVD APT 2223
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6876
Mailing Address - Country:US
Mailing Address - Phone:201-638-1001
Mailing Address - Fax:
Practice Address - Street 1:7600 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047
Practice Address - Country:US
Practice Address - Phone:201-694-5810
Practice Address - Fax:201-854-5797
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00143600363LA2200X
NJ26RN10599500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0158542Medicaid
121045OtherMEDICARE PTAN