Provider Demographics
NPI:1083149090
Name:GRUBB, EMILY M (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:GRUBB
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:8051 S EMERSON AVE STE 350
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8634
Practice Address - Country:US
Practice Address - Phone:317-859-1020
Practice Address - Fax:317-859-4040
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007217A363L00000X
IN28197743A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP02085734OtherRAILROAD MEDICARE
IN300004482Medicaid
IN266180C08OtherTRADITIONAL MEDICARE