Individual
STACY L GRUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPSW
Contact information
Practice address
PO BOX 533, FORT WINGATE, NM 87316-0533
(505) 870-0227
Mailing address
PO BOX 533, FORT WINGATE, NM 87316-0533
(505) 870-0227
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1509
NM
Other
Enumeration date
10/01/2025
Last updated
10/01/2025
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