Provider Demographics
NPI:1336556679
Name:GRUTZ, STEPHANIE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GRUTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BIRCH RDG N
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-9581
Mailing Address - Country:US
Mailing Address - Phone:563-663-1248
Mailing Address - Fax:
Practice Address - Street 1:7407 THUNDER VALLEY DR
Practice Address - Street 2:
Practice Address - City:PEOSTA
Practice Address - State:IA
Practice Address - Zip Code:52068-9475
Practice Address - Country:US
Practice Address - Phone:563-284-2422
Practice Address - Fax:563-200-7747
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA122623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner