Individual
MRS. AUDREY GROVENOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L P N
Contact information
Practice address
11010 225TH ST, QUEENS VILLAGE, QUEENS VILLAGE, NY 11429-2825
(718) 776-4683
Mailing address
11010 225TH ST, QUEENS VILLAGE, QUEENS VILLAGE, NY 11429-2825
(718) 776-4683
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
107886-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OSCAR1940
—
NY
Enumeration date
12/28/2009
Last updated
12/28/2009
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