Healthcare Provider Details

I. General information

NPI: 1154576536
Provider Name (Legal Business Name): CATHERINE M GRUBBS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 34 & 47
FORT THOMPSON SD
57339-0200
US

IV. Provider business mailing address

1323 BIA ROUTE 4 PO BOX 200
FT THOMPSON SD
57339
US

V. Phone/Fax

Practice location:
  • Phone: 605-245-1540
  • Fax: 605-245-2384
Mailing address:
  • Phone: 605-245-1540
  • Fax: 604-245-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberSD-LPN P006377
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: