Provider Demographics
NPI:1881627370
Name:GROVES, JILL M (CNM)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:GROVES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2595 N WYATT DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6104
Mailing Address - Country:US
Mailing Address - Phone:520-795-9912
Mailing Address - Fax:520-795-9934
Practice Address - Street 1:2595 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6104
Practice Address - Country:US
Practice Address - Phone:520-795-9912
Practice Address - Fax:520-795-9934
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM521367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44457863Medicaid