Provider Demographics
NPI:1013193754
Name:GROVES, TRACY CHASE (CRNA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:CHASE
Last Name:GROVES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LARAINE
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:16001 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4818
Mailing Address - Country:US
Mailing Address - Phone:248-849-5806
Mailing Address - Fax:248-849-5489
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-5806
Practice Address - Fax:248-849-5489
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704231405367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered