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General NPI Number Information
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NPI Number | 1326533175
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Entity Type | Organization
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Legal Business Name | THE WOMEN'S CLINIC AT THE GROVE
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 5740 GETWELL RD BUILDING 1, SUITE B
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City | SOUTHAVEN
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State | MS
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Zip | 38672
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Country | US
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Telephone | 662-470-7969
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Fax | 662-470-6289
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Provider Business Mailing Address
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Address Line | 5740 GETWELL RD BUILDING 1, SUITE B
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City | SOUTHAVEN
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State | MS
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Zip | 38672
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Country | US
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Telephone | 662-470-7969
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Fax |
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Authorized Official
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Title or Position | APRN/OWNER
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Name | DEBORAH VERUCCHI
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Credential |
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Telephone | 662-470-7969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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