Healthcare Provider Details

I. General information

NPI: 1477859460
Provider Name (Legal Business Name): GRUBB MED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10633 E APACHE TRL SUITE 106
APACHE JUNCTION AZ
85120-3383
US

IV. Provider business mailing address

10633 E APACHE TRL SUITE 106
APACHE JUNCTION AZ
85120-3383
US

V. Phone/Fax

Practice location:
  • Phone: 480-984-4912
  • Fax: 480-986-6436
Mailing address:
  • Phone: 480-984-1542
  • Fax: 480-986-6436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3828
License Number StateAZ

VIII. Authorized Official

Name: MS. MARY JOYCE (NONE) GRUBB
Title or Position: MEDICAL DIRECTOR
Credential: FNP-C
Phone: 480-984-1542