Healthcare Provider Details

I. General information

NPI: 1164726543
Provider Name (Legal Business Name): MARY JOYCE GRUBB FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 10/03/2013
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: 480-984-1542
  • 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:
Title or Position:
Credential:
Phone: