Healthcare Provider Details

I. General information

NPI: 1962871236
Provider Name (Legal Business Name): NADINE GROVE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 06/28/2023
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RED CREEK DR STE 110
ROCHESTER NY
14623-4273
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX MED
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-486-0147
  • Fax: 585-486-0673
Mailing address:
  • Phone: 585-486-0147
  • Fax: 585-486-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number625942
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: