Provider Demographics
NPI:1942227806
Name:GROVE, DENAE D (LRD)
Entity Type:Individual
Prefix:
First Name:DENAE
Middle Name:D
Last Name:GROVE
Suffix:
Gender:F
Credentials:LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-1833
Mailing Address - Country:US
Mailing Address - Phone:218-773-5800
Mailing Address - Fax:218-773-5888
Practice Address - Street 1:621 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1833
Practice Address - Country:US
Practice Address - Phone:218-773-5800
Practice Address - Fax:218-773-5888
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1558133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAMedicare UPIN