Healthcare Provider Details

I. General information

NPI: 1215435912
Provider Name (Legal Business Name): LISA MARIE GRUBBS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 W MAIN ST
HYANNIS MA
02601-3421
US

IV. Provider business mailing address

242 RAYNOR AVE
WHITMAN MA
02382-2152
US

V. Phone/Fax

Practice location:
  • Phone: 87-718-1145
  • Fax:
Mailing address:
  • Phone: 617-688-0803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2294514
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2294514
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: