Provider Demographics
NPI:1013615020
Name:GROVER, ISABELLA ROSE (LPN)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:ROSE
Last Name:GROVER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4158 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:NY
Mailing Address - Zip Code:14821-9753
Mailing Address - Country:US
Mailing Address - Phone:607-590-6196
Mailing Address - Fax:
Practice Address - Street 1:4158 S HILL RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:NY
Practice Address - Zip Code:14821-9753
Practice Address - Country:US
Practice Address - Phone:607-590-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse