Provider Demographics
NPI:1770851453
Name:GROVER, RITA J (RN)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:J
Last Name:GROVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2298
Mailing Address - Country:US
Mailing Address - Phone:315-468-1632
Mailing Address - Fax:315-468-1635
Practice Address - Street 1:301 VALLEY DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2298
Practice Address - Country:US
Practice Address - Phone:315-468-1632
Practice Address - Fax:315-468-1635
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308916 1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse