Provider Demographics
NPI:1598541518
Name:GROW, LIAN (RN)
Entity type:Individual
Prefix:
First Name:LIAN
Middle Name:
Last Name:GROW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1337 BLUE VALLEY DR STE 7
Practice Address - Street 2:
Practice Address - City:PEN ARGYL
Practice Address - State:PA
Practice Address - Zip Code:18072-1815
Practice Address - Country:US
Practice Address - Phone:610-654-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2025-02-04
Deactivation Date:2025-01-05
Deactivation Code:
Reactivation Date:2025-01-14
Provider Licenses
StateLicense IDTaxonomies
PARN719432163W00000X
PASP031292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse