Provider Demographics
NPI:1346425006
Name:GROOVER, TERRI L (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:GROOVER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 TILTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-5714
Mailing Address - Country:US
Mailing Address - Phone:267-334-3926
Mailing Address - Fax:
Practice Address - Street 1:2996 TILTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-5714
Practice Address - Country:US
Practice Address - Phone:267-334-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN309462L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse