1720230675 NPI number — DR. PRETRESCIA MARIE GRUBBS DNP, ACNP, APRN

Table of content: DR. PRETRESCIA MARIE GRUBBS DNP, ACNP, APRN (NPI 1720230675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720230675 NPI number — DR. PRETRESCIA MARIE GRUBBS DNP, ACNP, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUBBS
Provider First Name:
PRETRESCIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, ACNP, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALKER
Provider Other First Name:
PRETRESCIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720230675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 SAINT VINCENT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-5423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-552-3368
Provider Business Mailing Address Fax Number:
501-552-4555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHI-ST. VINCENT INFIRMARY-HOSPITALIST GROUP
Provider Second Line Business Practice Location Address:
2 SAINT VINCENT CIRCLE
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-552-3368
Provider Business Practice Location Address Fax Number:
501-552-4555
Provider Enumeration Date:
10/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  AO1609 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: A01609 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)