Provider Demographics
NPI:1861994626
Name:JENNIFER GRUNE DNP FNP-BC
Entity type:Organization
Organization Name:JENNIFER GRUNE DNP FNP-BC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/APRN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-333-3450
Mailing Address - Street 1:16-590 OLD VOLCANO RD STE B
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8158
Mailing Address - Country:US
Mailing Address - Phone:808-333-3450
Mailing Address - Fax:808-930-4721
Practice Address - Street 1:16-590 OLD VOLCANO RD STE B
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8158
Practice Address - Country:US
Practice Address - Phone:808-333-3450
Practice Address - Fax:808-930-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2244363LF0000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty