Provider Demographics
NPI:1346555018
Name:GRUEN, LORI ANN (RN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:GRUEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3032 LUCAS RD
Mailing Address - Street 2:
Mailing Address - City:HAMERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45130-8452
Mailing Address - Country:US
Mailing Address - Phone:937-379-9663
Mailing Address - Fax:
Practice Address - Street 1:3032 LUCAS RD
Practice Address - Street 2:
Practice Address - City:HAMERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45130-8452
Practice Address - Country:US
Practice Address - Phone:937-379-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-207635163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse