1356476436 NPI number — MRS. NANCY J GROVER PMHNP

Table of content: MRS. NANCY J GROVER PMHNP (NPI 1356476436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356476436 NPI number — MRS. NANCY J GROVER PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROVER
Provider First Name:
NANCY
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOGAN
Provider Other First Name:
NANCY
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356476436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47 KENNEBEC RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPDEN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04444-1315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-862-2136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 CEDAR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04402-0425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-947-0366
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  026543 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00039153 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".