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General NPI Number Information
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NPI Number | 1124127071
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Entity Type | Individual
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Provider Name | SUZANNE M GROVE ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 66 N 6TH ST
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City | POMEROY
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State | WA
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Zip | 99347-9705
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Country | US
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Telephone | 509-843-1591
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Fax | 509-843-1234
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Provider Business Mailing Address
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Address Line | 66 N 6TH ST
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City | POMEROY
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State | WA
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Zip | 99347-9705
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Country | US
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Telephone | 509-843-1591
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Fax | 509-843-1234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP30000968
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License Number State | WA
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