Provider Demographics
NPI:1063011781
Name:GROSE, JUDY E (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:E
Last Name:GROSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3873 MAPLE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-5055
Mailing Address - Country:US
Mailing Address - Phone:304-327-8846
Mailing Address - Fax:304-327-0722
Practice Address - Street 1:3873 MAPLE ACRES RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-5055
Practice Address - Country:US
Practice Address - Phone:304-327-8846
Practice Address - Fax:304-327-0722
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV74280171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator