MEDICARE: BETH GROVES L.P.N.

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	164W00000X	Licensed Practical Nurse	PN 096803	OH

General Provider Information

NPI Number	:	1598794174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH GROVES L.P.N.

Provider Business Mailing Address
First Line	:	PO BOX 14
Second Line	:
City	:	MC DERMOTT
State	:	OH
Zip	:	45652-0014
Country	:	US
Telephone Number	:	740-259-2884
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 MCDERMOTT RUSHTOWN ROAD
Second Line	:
City	:	MC DERMOTT
State	:	OH
Zip	:	45652-0014
Country	:	US
Telephone Number	:	740-259-2884
Fax Number	:

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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