MEDICARE: LISA MYERS GRUBB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0000X	Wound Care Registered Nurse	R109114	MD
2	363LF0000X	Family Nurse Practitioner	R109114	MD

General Provider Information

NPI Number	:	1427913342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MYERS GRUBB

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-0000
Fax Number	:	410-500-4266

Provider Business Practice Location Address
First Line	:	4940 EASTERN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-2780
Country	:	US
Telephone Number	:	410-550-0526
Fax Number	:	410-550-0100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	02/20/2026

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Directions to “ LISA MYERS GRUBB ” Practice Location

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