MEDICARE: SHARECKA GRUBBS RN

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	163W00000X	Registered Nurse	932852	TX

General Provider Information

NPI Number	:	1497312870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARECKA GRUBBS RN

Provider Business Mailing Address
First Line	:	621 GRIFFIN ST
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75146-2329
Country	:	US
Telephone Number	:	214-434-3141
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 GRIFFIN ST
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75146-2329
Country	:	US
Telephone Number	:	214-434-3141
Fax Number	:

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

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	09/29/2021

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