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General NPI Number Information
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NPI Number | 1760631055
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Entity Type | Individual
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Provider Name | PATRICIA GAIL ROLEN GRUBB FNP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 719 GREEN VALLEY RD SUITE 101
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City | GREENSBORO
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State | NC
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Zip | 27408-7014
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Country | US
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Telephone | 336-370-0277
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Fax | 336-333-9757
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Provider Business Mailing Address
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Address Line | 1200 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1004
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Country | US
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Telephone | 336-832-7000
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200293
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License Number State | NC
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