Individual
DIANE GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
815 N CLARE AVE, HARRISON, MI 48625-9194
(989) 539-4434
(989) 539-4480
Mailing address
815 N CLARE AVE, HARRISON, MI 48625-9194
(989) 539-4434
(989) 539-4480
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
DG004869
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG004869
STATE LICENSE
MI
Enumeration date
09/12/2006
Last updated
02/26/2009
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