Provider Demographics
NPI:1902377880
Name:GRUBB, ABBAGAIL (NP-BC)
Entity Type:Individual
Prefix:
First Name:ABBAGAIL
Middle Name:
Last Name:GRUBB
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 W POINT RD SE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8639
Mailing Address - Country:US
Mailing Address - Phone:740-475-9192
Mailing Address - Fax:
Practice Address - Street 1:2405 N COLUMBUS ST STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8189
Practice Address - Country:US
Practice Address - Phone:740-689-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily