Provider Demographics
NPI:1760027577
Name:NGOLO-GRUBB, ROSE A
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:A
Last Name:NGOLO-GRUBB
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 1:8310 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3520
Mailing Address - Country:US
Mailing Address - Phone:913-271-1106
Mailing Address - Fax:
Practice Address - Street 1:8310 GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3520
Practice Address - Country:US
Practice Address - Phone:913-271-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)