Provider Demographics
NPI:1962788109
Name:GRUBB, CARRIE JOANN (LPN)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:JOANN
Last Name:GRUBB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 FALLERT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1015
Mailing Address - Country:US
Mailing Address - Phone:513-430-5414
Mailing Address - Fax:
Practice Address - Street 1:408 FALLERT AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1015
Practice Address - Country:US
Practice Address - Phone:513-430-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN1335546-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse