Healthcare Provider Details

I. General information

NPI: 1376635730
Provider Name (Legal Business Name): DAWN A GROVE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 N EL DORADO PL STE 103
TUCSON AZ
85715-4607
US

IV. Provider business mailing address

1161 N EL DORADO PL STE 103
TUCSON AZ
85715-4607
US

V. Phone/Fax

Practice location:
  • Phone: 207-487-1085
  • Fax:
Mailing address:
  • Phone: 520-570-1460
  • Fax: 520-570-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN056795
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number3342
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: