Provider Demographics
NPI:1447378138
Name:GROVES, WILANNA PEARL (STNA)
Entity type:Individual
Prefix:
First Name:WILANNA
Middle Name:PEARL
Last Name:GROVES
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-5825
Mailing Address - Country:US
Mailing Address - Phone:419-889-9437
Mailing Address - Fax:
Practice Address - Street 1:824 CENTER ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-5825
Practice Address - Country:US
Practice Address - Phone:419-889-9437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400543831006374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide