Provider Demographics
NPI:1699582056
Name:GRUBER, NATALIE JAYNE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JAYNE
Last Name:GRUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:JAYNE
Other - Last Name:BRESSERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:368 LOVEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3714
Mailing Address - Country:US
Mailing Address - Phone:214-454-5712
Mailing Address - Fax:
Practice Address - Street 1:368 LOVEMAN AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3714
Practice Address - Country:US
Practice Address - Phone:214-454-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant