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Individual
JENNIFER LYNN BENNETT GRUBE
Active
Individual
JENNIFER LYNN BENNETT GRUBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101226165
VA
208M00000X
Hospitalist Physician
Primary
0101226165
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427006444
—
VA
05
—
7100047940
—
KY
Enumeration date
05/04/2006
Last updated
02/27/2012
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