Provider Demographics
NPI:1952383630
Name:GRUDELL, BETH ANNE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:GRUDELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:HUFFMYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 POLARIS PKWY STE 3400
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7998
Practice Address - Country:US
Practice Address - Phone:614-533-3475
Practice Address - Fax:614-533-3480
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily