Doctor Name: | ANARIZA GRUSH |
NPI Number: | 1013306166 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | CNP-02554 |
Business Practice Address: | 1001 W Broadway Farmington, NM - 874015638 |
Business Phone Number: | 5053274796 |
Business Fax Number: | |
Mailing Address: | 604 Florida Meadows Ln, DURANGO |
State: | CO |
Postal Code: | 813036817 |
Phone Number: | 7209357462 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2015 |
NPI Last Update Date: | 01/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LC1500X |
License Number: | CNP-02554 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |