Basic Information
| Provider Information | |||||||||
| NPI: | 1467461384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROVES | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3192 MINERAL SPRINGS TRL | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488589663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897732851 | ||||||||
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| Practice Location | |||||||||
| Address1: | 703 N MCEWAN ST | ||||||||
| Address2: | |||||||||
| City: | CLARE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486171440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898025000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 4704123266 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 4590040 | 05 | MI | MEDICAID |