Individual
SUZANNE M GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
66 N 6TH ST, POMEROY, WA 99347-9705
(509) 843-1591
(509) 843-1234
Mailing address
66 N 6TH ST, POMEROY, WA 99347-9705
(509) 843-1591
(509) 843-1234
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP30000968
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
805880200
ID DSHS
ID
05
—
9604000
—
WA
01
—
GAB03061
MEDICARE PTAN
WA
Enumeration date
09/21/2006
Last updated
07/13/2010
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