Individual
MS. LORRAINE GWEN GRUBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
412 NORTH C STREET, CRIPPLE CREEK, CO 80813
(719) 200-9668
Mailing address
3205 N ACADEMY BLVD, SUITE 130, COLORADO SPRINGS, CO 80917-5101
(719) 632-5700
(719) 344-7837
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1516
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44985738
—
CO
Enumeration date
10/25/2005
Last updated
12/08/2014
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