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Individual

MS. JENNIFER GRUBER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APNP

Contact information

Practice address
650 MCMILLEN ST, FORT ATKINSON, WI 53538-1275
(920) 563-8900
Mailing address
PO BOX 249, FORT ATKINSON, WI 53538-0249
(920) 563-4466

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6307
WI
363LF0000X
Family Nurse Practitioner
6307
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1134515703
WI
Enumeration date
04/10/2015
Last updated
10/07/2022
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