Provider Demographics
NPI:1265669725
Name:GROVER, SARA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:GROVER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E CHIPPEWA ST
Mailing Address - Street 2:PO BOX 1224
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1609
Mailing Address - Country:US
Mailing Address - Phone:231-829-3464
Mailing Address - Fax:
Practice Address - Street 1:209 E CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1609
Practice Address - Country:US
Practice Address - Phone:231-829-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703098727164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse