Individual
MARILYN S GROVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2600 OAKLAND AVE, ELKHART, IN 46517-1533
(574) 533-1234
(574) 537-2652
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
71001259A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000533123
ANTHEM PIN
—
05
—
200361200
—
IN
01
—
P00106755
RAILROAD MEDICARE PIN
IN
Enumeration date
06/15/2006
Last updated
08/09/2011
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