Provider Demographics
NPI:1497212260
Name:GRUGIN, CATRINA RENEE
Entity Type:Individual
Prefix:
First Name:CATRINA
Middle Name:RENEE
Last Name:GRUGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 SMOKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-9563
Mailing Address - Country:US
Mailing Address - Phone:301-643-4502
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER, ATTN MCHJ-CLQ-C
Practice Address - Street 2:9040 JACKSON AVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-968-0982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212929163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse