Provider Demographics
NPI:1174177414
Name:GROVE, RENEE E (CNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:E
Last Name:GROVE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:E
Other - Last Name:NIEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:460 POLARIS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6090
Mailing Address - Country:US
Mailing Address - Phone:614-865-3125
Mailing Address - Fax:614-529-4270
Practice Address - Street 1:460 POLARIS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6090
Practice Address - Country:US
Practice Address - Phone:614-865-3125
Practice Address - Fax:614-529-4270
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0363533Medicaid