Provider Demographics
NPI:1104515915
Name:GROVE, MARQUONA JOHNISHA
Entity type:Individual
Prefix:
First Name:MARQUONA
Middle Name:JOHNISHA
Last Name:GROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:D
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:227 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-3006
Mailing Address - Country:US
Mailing Address - Phone:484-790-5206
Mailing Address - Fax:
Practice Address - Street 1:227 CHARLES ST
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3006
Practice Address - Country:US
Practice Address - Phone:484-790-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide