1144501057 NPI number — MRS. ANNA MARIE GRUBENHOFF FNP-BC

Table of content: MRS. ANNA MARIE GRUBENHOFF FNP-BC (NPI 1144501057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144501057 NPI number — MRS. ANNA MARIE GRUBENHOFF FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUBENHOFF
Provider First Name:
ANNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOERST
Provider Other First Name:
ANNA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144501057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 WESLEY AVE
Provider Second Line Business Mailing Address:
STE N
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45212-2298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-246-7800
Provider Business Mailing Address Fax Number:
513-246-7852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 ANDERSON FERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45238-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-246-7000
Provider Business Practice Location Address Fax Number:
513-246-5627
Provider Enumeration Date:
09/06/2011

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: 363LF0000X , with the licence number:  RN.343840 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: COA.12691-NP . This is a "OHIO LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".