Provider Demographics
NPI:1821718693
Name:GRUBER, CASSANDRA MARY (PA-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARY
Last Name:GRUBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 SE CARMEN WAY
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-2211
Mailing Address - Country:US
Mailing Address - Phone:425-770-5678
Mailing Address - Fax:
Practice Address - Street 1:76 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1827
Practice Address - Country:US
Practice Address - Phone:541-475-3874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA222387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant