Provider Demographics
NPI:1396729794
Name:GRUBICH, GAYLE MARIE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:MARIE
Last Name:GRUBICH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3188
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-3188
Mailing Address - Country:US
Mailing Address - Phone:509-826-1600
Mailing Address - Fax:509-826-3617
Practice Address - Street 1:529 JASMINE ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9589
Practice Address - Country:US
Practice Address - Phone:509-826-1600
Practice Address - Fax:509-826-3617
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007990363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9656745Medicaid
WA0238881OtherL&I
WA9656745Medicaid