Provider Demographics
NPI:1457352585
Name:GRUER, JACQUELYN (CNM)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:GRUER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4342 HAIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1749
Mailing Address - Country:US
Mailing Address - Phone:513-542-8259
Mailing Address - Fax:
Practice Address - Street 1:4244 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-2048
Practice Address - Country:US
Practice Address - Phone:513-681-4900
Practice Address - Fax:513-853-8432
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-187380/NM01412367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH201488810028OtherCARESOURCE
OH0629789Medicaid
OH109026341696OtherHUMANA