Provider Demographics
NPI:1588946784
Name:GROVES, TONYA YVETTE (LPN)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:YVETTE
Last Name:GROVES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 BRADFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2504
Mailing Address - Country:US
Mailing Address - Phone:937-301-0972
Mailing Address - Fax:
Practice Address - Street 1:728 BRADFIELD DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-2504
Practice Address - Country:US
Practice Address - Phone:937-301-0972
Practice Address - Fax:937-301-0972
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143954-M-IV164W00000X
OHRN.436889163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse