=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386725836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE LYNN GROVE CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | KABGAYI SCHOOL OF NURSING
-----------------------------------------------------
City | KABGAYI
-----------------------------------------------------
State | SOUTHERN PROVINCE
-----------------------------------------------------
Zip | BP 66
-----------------------------------------------------
Country | RW
-----------------------------------------------------
Telephone | 250789452939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 YOUNGS RD
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08619-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 209005698
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 08299-NM
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------