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General NPI Number Information
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NPI Number | 1215435912
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Entity Type | Individual
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Provider Name | LISA MARIE GRUBBS CNP
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Gender | Female
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 687 W MAIN ST
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City | HYANNIS
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State | MA
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Zip | 02601-3421
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Country | US
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Telephone | 87-718-1145
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Fax |
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Provider Business Mailing Address
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Address Line | 242 RAYNOR AVE
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City | WHITMAN
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State | MA
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Zip | 02382-2152
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Country | US
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Telephone | 617-688-0803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN2294514
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN2294514
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License Number State | MA
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