Provider Demographics
NPI:1396482436
Name:GRUBBS, LAVITA S
Entity type:Individual
Prefix:
First Name:LAVITA
Middle Name:S
Last Name:GRUBBS
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 1:34 HIGHGROVE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1172
Mailing Address - Country:US
Mailing Address - Phone:516-660-7671
Mailing Address - Fax:
Practice Address - Street 1:34 HIGHGROVE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1172
Practice Address - Country:US
Practice Address - Phone:516-660-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327552164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse