Provider Demographics
NPI:1275782369
Name:GRUBB, ASHLEY B (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:B
Last Name:GRUBB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450B WASHINGTON JACKSON RD STE 108
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-7601
Mailing Address - Country:US
Mailing Address - Phone:937-456-8330
Mailing Address - Fax:937-456-8335
Practice Address - Street 1:450B WASHINGTON JACKSON RD STE 108
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7601
Practice Address - Country:US
Practice Address - Phone:937-456-8330
Practice Address - Fax:937-456-8335
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075457Medicaid
OHPA31735OtherMEDICARE PTAN
OH0075457Medicaid
OHPA31736OtherMEDICARE PTAN