MEDICARE: ABBAGAIL GRUBB NP-BC

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.024038	OH

General Provider Information

NPI Number	:	1902377880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBAGAIL GRUBB NP-BC

Provider Business Mailing Address
First Line	:	2848 W POINT RD SE
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-8639
Country	:	US
Telephone Number	:	740-475-9192
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 N COLUMBUS ST STE 100
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-8189
Country	:	US
Telephone Number	:	740-689-4480
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	03/12/2019

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