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General NPI Number Information
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NPI Number | 1992955314
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Entity Type | Individual
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Provider Name | AMY LOUISE GRUBE FNP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 280 PATTONSVILLE RD
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City | JACKSON
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State | OH
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Zip | 45640-9452
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Country | US
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Telephone | 740-395-8677
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Fax | 740-395-8834
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Provider Business Mailing Address
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Address Line | 90 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1560
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Country | US
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Telephone | 740-395-8677
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Fax | 740-395-8834
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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 | 10237
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP10237
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License Number State | OH
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