Provider Demographics
NPI:1780609719
Name:GRUBER, JOANN (NP)
Entity type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:GRUBER
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:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0058
Mailing Address - Country:US
Mailing Address - Phone:541-201-3173
Mailing Address - Fax:541-371-5551
Practice Address - Street 1:1607 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2400
Practice Address - Country:US
Practice Address - Phone:541-201-3173
Practice Address - Fax:541-371-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050217363LF0000X, 363LP0808X
OR201050218363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
R181125Medicare PIN