Provider Demographics
NPI:1275750655
Name:GROVER, BEVERLY A (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:GROVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W330 S4551 COUNTY HIGHWAY E
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9461
Mailing Address - Country:US
Mailing Address - Phone:262-442-6251
Mailing Address - Fax:
Practice Address - Street 1:1702 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1616
Practice Address - Country:US
Practice Address - Phone:414-933-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1006-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner