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General NPI Number Information
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NPI Number | 1336594720
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Entity Type | Individual
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Provider Name | KERRI GROVER RN
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Gender | Female
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 1 EAGLE ROAD COAST GUARD ISLAND BLDG 1 USCG BASE ALAMEDA MEDICAL CLINIC
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City | ALAMEDA
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State | CA
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Zip | 94501
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Country | US
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Telephone | 510-437-3775
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Fax |
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Provider Business Mailing Address
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Address Line | 3047B SHASTA DR
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City | ALAMEDA
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State | CA
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Zip | 94501-8016
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Country | US
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Telephone | 510-437-3775
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95048023
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00120958
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License Number State | WA
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