Provider Demographics
NPI:1295150928
Name:GROVER, REGINA RENE (ARNP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:RENE
Last Name:GROVER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 DAKOTA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3696
Mailing Address - Country:US
Mailing Address - Phone:402-494-6033
Mailing Address - Fax:
Practice Address - Street 1:3900 DAKOTA AVE STE 6
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3696
Practice Address - Country:US
Practice Address - Phone:402-494-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily