Provider Demographics
NPI:1790672749
Name:GRUBE, EMMA MARIE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:MARIE
Last Name:GRUBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5623 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2235
Mailing Address - Country:US
Mailing Address - Phone:402-890-5091
Mailing Address - Fax:
Practice Address - Street 1:2117 226TH ST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:NE
Practice Address - Zip Code:68347-1809
Practice Address - Country:US
Practice Address - Phone:402-670-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27748164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse