Provider Demographics
NPI:1497266282
Name:GROVE, NIKITA ANNE (RDN)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:ANNE
Last Name:GROVE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S MARKET ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2308
Mailing Address - Country:US
Mailing Address - Phone:717-282-1864
Mailing Address - Fax:717-678-6322
Practice Address - Street 1:23 S MARKET ST STE 201
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2308
Practice Address - Country:US
Practice Address - Phone:717-282-1864
Practice Address - Fax:717-678-6322
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty