Provider Demographics
NPI:1487888350
Name:GROVE, COURTNEY NICOLE (MPH, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:NICOLE
Last Name:GROVE
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 NAVAJO PATH
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3632
Mailing Address - Country:US
Mailing Address - Phone:814-571-9644
Mailing Address - Fax:
Practice Address - Street 1:2603 NAVAJO PATH
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3632
Practice Address - Country:US
Practice Address - Phone:814-571-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003714133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3727333000OtherINDEPENDENCE BLUE CROSS