Provider Demographics
NPI:1679672661
Name:GRUBER, KAREN J (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:GRUBER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 BROKEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9603
Mailing Address - Country:US
Mailing Address - Phone:651-402-9328
Mailing Address - Fax:
Practice Address - Street 1:1519 BROKEN OAK COURT
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55038-9603
Practice Address - Country:US
Practice Address - Phone:651-402-9328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0867434367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN457218100Medicaid
MN457218100Medicaid