Provider Demographics
NPI:1962223115
Name:GRUBBS, CHRISTINA DAWN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DAWN
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 1:1326 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-1232
Mailing Address - Country:US
Mailing Address - Phone:681-215-9586
Mailing Address - Fax:
Practice Address - Street 1:1326 7TH AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1232
Practice Address - Country:US
Practice Address - Phone:681-215-9586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant