Provider Demographics
NPI:1710112933
Name:GROVE, MARY A (ACNP, ANP, PHD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:A
Last Name:GROVE
Suffix:
Gender:F
Credentials:ACNP, ANP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 ABBY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-6500
Mailing Address - Country:US
Mailing Address - Phone:615-554-9047
Mailing Address - Fax:
Practice Address - Street 1:1003 ABBY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-6500
Practice Address - Country:US
Practice Address - Phone:615-554-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014367363LA2100X, 363LA2200X
SC3865363LA2100X, 363LA2200X
NYF432395-01363LA2100X
NYF310865-01363LA2200X
NJ26NJ00879100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health