Provider Demographics
NPI:1669074662
Name:GROVER, STACY D
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:D
Last Name:GROVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:D
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:778 BEAVER RUN RD SE
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-9649
Mailing Address - Country:US
Mailing Address - Phone:614-519-5864
Mailing Address - Fax:
Practice Address - Street 1:778 BEAVER RUN RD SE
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:OH
Practice Address - Zip Code:43025-9649
Practice Address - Country:US
Practice Address - Phone:614-519-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker