Provider Demographics
NPI:1558027060
Name:GRUBER, PATRICIA (MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1305
Mailing Address - Country:US
Mailing Address - Phone:414-217-9738
Mailing Address - Fax:
Practice Address - Street 1:921 2ND AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1305
Practice Address - Country:US
Practice Address - Phone:414-217-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist