Healthcare Provider Details

I. General information

NPI: 1659429249
Provider Name (Legal Business Name): ASHLAND INTEGRATIVE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 ASHLAND ST
ASHLAND OR
97520-2328
US

IV. Provider business mailing address

PO BOX 1300
ASHLAND OR
97520-0058
US

V. Phone/Fax

Practice location:
  • Phone: 541-201-3173
  • Fax: 541-201-3173
Mailing address:
  • Phone: 541-201-3173
  • Fax: 561-427-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201050217
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201050218
License Number StateOR

VIII. Authorized Official

Name: MS. JOANN ELLEN GRUBER
Title or Position: PRESIDENT
Credential: NP
Phone: 541-201-3173