Provider Demographics
NPI:1356476436
Name:GROVER, NANCY J (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:J
Last Name:GROVER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 KENNEBEC RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1315
Mailing Address - Country:US
Mailing Address - Phone:207-862-2136
Mailing Address - Fax:
Practice Address - Street 1:42 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04402-0425
Practice Address - Country:US
Practice Address - Phone:207-947-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME026543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00039153OtherRAILROAD MEDICARE
MENS8052Medicare ID - Type Unspecified
MEP42453Medicare UPIN