Provider Demographics
NPI:1851996540
Name:GRUBER, STANLEY ALAN (RN)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:ALAN
Last Name:GRUBER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2012
Mailing Address - Country:US
Mailing Address - Phone:206-225-0088
Mailing Address - Fax:
Practice Address - Street 1:30601 34TH PL S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-3201
Practice Address - Country:US
Practice Address - Phone:206-225-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60066292163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse