Individual
AMY LOUISE GRUBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
280 PATTONSVILLE RD, JACKSON, OH 45640-9452
(740) 395-8677
(740) 395-8834
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 395-8677
(740) 395-8834
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
10237
WV
363LF0000X
Family Nurse Practitioner
Primary
NP10237
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
282601
OHIO MEDICAID UNISON
OH
01
—
2878444
OHIO MEDICAID MOLINA
OH
05
—
2878444
—
OH
01
—
310917085217
OHIO MEDICAID CARESOURCE
OH
05
—
3810016002
—
WV
01
—
P00781887
RR MEDICARE
OH
Enumeration date
09/22/2008
Last updated
08/07/2014
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