Healthcare Provider Details

I. General information

NPI: 1043833916
Provider Name (Legal Business Name): RACHEL MARLEEN GROVE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 STATE ROUTE 28 STE A100
MILFORD OH
45150-2154
US

IV. Provider business mailing address

1171 STATE ROUTE 28 STE A100
MILFORD OH
45150-2154
US

V. Phone/Fax

Practice location:
  • Phone: 513-831-4811
  • Fax: 513-831-0169
Mailing address:
  • Phone: 513-831-4811
  • Fax: 513-831-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50007109RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: