Provider Demographics
NPI:1619239712
Name:RUIZ-GRUWELL, ANNA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RUIZ-GRUWELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIA
Other - Last Name:GRUWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2275 W BROADWAY ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-2902
Mailing Address - Country:US
Mailing Address - Phone:208-529-3967
Mailing Address - Fax:208-419-0684
Practice Address - Street 1:2275 W BROADWAY ST
Practice Address - Street 2:SUITE G
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-2902
Practice Address - Country:US
Practice Address - Phone:208-529-3967
Practice Address - Fax:208-419-0684
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1174A363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily