Provider Demographics
NPI:1164857702
Name:GROVER, BONNIE GENEVIEVE (RN)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:GENEVIEVE
Last Name:GROVER
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 1:199 SPURWINK RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8607
Mailing Address - Country:US
Mailing Address - Phone:207-730-1294
Mailing Address - Fax:207-767-6524
Practice Address - Street 1:199 SPURWINK RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8607
Practice Address - Country:US
Practice Address - Phone:207-730-1294
Practice Address - Fax:207-767-6524
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN34658163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health