Healthcare Provider Details

I. General information

NPI: 1053912345
Provider Name (Legal Business Name): ASHLYN ANNE GRUBER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 KAPIOLANI BLVD STE 705
HONOLULU HI
96813-5241
US

IV. Provider business mailing address

770 KAPIOLANI BLVD STE 705
HONOLULU HI
96813-5241
US

V. Phone/Fax

Practice location:
  • Phone: 808-597-8799
  • Fax:
Mailing address:
  • Phone: 808-597-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10660
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-1446
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: