Provider Demographics
NPI:1396847489
Name:GRUBE, WENDY (CRNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GRUBE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 UNION BLVD
Mailing Address - Street 2:REAR
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109
Mailing Address - Country:US
Mailing Address - Phone:610-770-9077
Mailing Address - Fax:610-770-9220
Practice Address - Street 1:1409 UNION BLVD
Practice Address - Street 2:REAR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109
Practice Address - Country:US
Practice Address - Phone:610-770-9077
Practice Address - Fax:610-770-9220
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP000680B363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology