Provider Demographics
NPI:1558528364
Name:GRUBER, MEGAN (ARNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2266
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-2266
Mailing Address - Country:US
Mailing Address - Phone:360-756-9793
Mailing Address - Fax:360-752-9007
Practice Address - Street 1:302 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6580
Practice Address - Country:US
Practice Address - Phone:360-756-9793
Practice Address - Fax:360-752-9007
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200340162RN390200000X
WAAP60056969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
0243797OtherLABOR & INDUSTRIES
WA9659780Medicaid
0243797OtherLABOR & INDUSTRIES