MEDICARE: BEVERLY A GROVER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	1006-033	WI

General Provider Information

NPI Number	:	1275750655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY A GROVER NP

Provider Business Mailing Address
First Line	:	W330 S4551 COUNTY HIGHWAY E
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53189-9461
Country	:	US
Telephone Number	:	262-442-6251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 W WALNUT ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1616
Country	:	US
Telephone Number	:	414-933-1590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	04/21/2011

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