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General NPI Number Information
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NPI Number | 1477859460
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Entity Type | Organization
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Legal Business Name | GRUBB MED
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 10633 E APACHE TRL SUITE 106
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-3383
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Country | US
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Telephone | 480-984-4912
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Fax | 480-986-6436
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Provider Business Mailing Address
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Address Line | 10633 E APACHE TRL SUITE 106
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-3383
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Country | US
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Telephone | 480-984-1542
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Fax | 480-986-6436
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MS. MARY JOYCE (NONE) GRUBB
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Credential | FNP-C
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Telephone | 480-984-1542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP3828
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License Number State | AZ
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