Provider Demographics
NPI:1437343779
Name:GROVES, MARIE ELIZABETH (MS, RD, CNSC, LD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:GROVES
Suffix:
Gender:F
Credentials:MS, RD, CNSC, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 BRYN MAHR LN
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-6018
Mailing Address - Country:US
Mailing Address - Phone:972-754-7498
Mailing Address - Fax:972-722-1242
Practice Address - Street 1:17111 PRESTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1229
Practice Address - Country:US
Practice Address - Phone:972-754-7498
Practice Address - Fax:210-519-3000
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07645133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT07645OtherLICENSED DIETITIAN
895816OtherREGISTERD DIETIITIAN