Provider Demographics
NPI:1609013101
Name:GROVE, SHERRY LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LEE
Last Name:GROVE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LEE
Other - Last Name:GIVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1406 RAPIDS TRAIL
Mailing Address - Street 2:SHERRY GROVE
Mailing Address - City:NEKOOSA
Mailing Address - State:WI
Mailing Address - Zip Code:54457-8689
Mailing Address - Country:US
Mailing Address - Phone:717-325-3335
Mailing Address - Fax:
Practice Address - Street 1:1406 RAPIDS TRAIL
Practice Address - Street 2:
Practice Address - City:NAKOOSA
Practice Address - State:WI
Practice Address - Zip Code:54457
Practice Address - Country:US
Practice Address - Phone:717-325-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28968-031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse