Provider Demographics
NPI:1902089477
Name:GROVER, DEBORAH KAY (LPN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:GROVER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CYPRESS CT
Mailing Address - Street 2:APT#2
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-7534
Mailing Address - Country:US
Mailing Address - Phone:607-319-5110
Mailing Address - Fax:
Practice Address - Street 1:210 CYPRESS CT
Practice Address - Street 2:APT#2
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-7534
Practice Address - Country:US
Practice Address - Phone:607-319-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098525-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse