Healthcare Provider Details

I. General information

NPI: 1780007880
Provider Name (Legal Business Name): MARIANNE GRUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 LAFAYETTE RD UNIT108
HAMPTON NH
03842-2206
US

IV. Provider business mailing address

387 LAFAYETTE RD UNIT108
HAMPTON NH
03842-2206
US

V. Phone/Fax

Practice location:
  • Phone: 603-601-7105
  • Fax: 603-601-7103
Mailing address:
  • Phone: 603-601-7105
  • Fax: 603-601-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number0633937
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: