Healthcare Provider Details

I. General information

NPI: 1285771097
Provider Name (Legal Business Name): ASTRID MARIE GROVE R.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAUNA MARIE DILLARD LM

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 OAK ST.
STEAMBOAT SPINGS CO
80487
US

IV. Provider business mailing address

PO BOX 773398
STEAMBOAT SPRINGS CO
80477
US

V. Phone/Fax

Practice location:
  • Phone: 970-343-2968
  • Fax:
Mailing address:
  • Phone: 970-343-2968
  • Fax: 800-303-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberLM 246
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number107-0000036
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number00000181
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: