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Individual

LACIE GRUBBE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN,BSN

Contact information

Practice address
5009 CANA CV, AUSTIN, TX 78749-4687
(918) 504-4376
Mailing address
5009 CANA CV, AUSTIN, TX 78749-4687

Taxonomy

Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
786889
TX

Other

Enumeration date
09/02/2012
Last updated
09/02/2012
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