Individual
LISA ANN GRUBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110001151
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295747202
OPTIMA HEALTH PLAN
VA
01
—
371194700
BLACK LUNG
VA
01
—
540506332048
TRICARE/CHAMPUS
VA
01
—
P00922434
RAILROAD MEDICARE
VA
Enumeration date
08/12/2006
Last updated
04/30/2014
Update your record
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