Provider Demographics
NPI:1609317080
Name:GRUBER, DEIRDRE (APRN)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MEADOW ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1719
Mailing Address - Country:US
Mailing Address - Phone:203-946-6364
Mailing Address - Fax:203-946-6364
Practice Address - Street 1:54 MEADOW ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1719
Practice Address - Country:US
Practice Address - Phone:203-946-6364
Practice Address - Fax:203-946-6364
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily