Provider Demographics
NPI:1568900868
Name:GROVER, SHANEDOLYN (NP)
Entity Type:Individual
Prefix:
First Name:SHANEDOLYN
Middle Name:
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 1:827 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3602
Mailing Address - Country:US
Mailing Address - Phone:225-869-9200
Mailing Address - Fax:
Practice Address - Street 1:827 N PINE ST
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3602
Practice Address - Country:US
Practice Address - Phone:225-869-9200
Practice Address - Fax:225-869-9241
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily