Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F332449 | NY |
NPI | 1003808296 |
---|---|
Provider Name | Mrs. Julie Grover |
First Address | Perry, NY 14530-1342 |
Second Address | Perry, NY 14530-1342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 26/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01922930 | (05) | NY |
S84860 | (02) |