Basic Information
| Provider Information | |||||||||
| NPI: | 1356657183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROVER | ||||||||
| FirstName: | MEL | ||||||||
| MiddleName: | EVA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 LOUISIANA BLVD NE STE 401 | ||||||||
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| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871107020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052604300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 JEFFERSON ST | ||||||||
| Address2: | APT. 3L | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112066357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127291326 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 59326 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.