Provider Demographics
NPI:1053672501
Name:GROFF, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GROFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:TURIN
Mailing Address - State:NY
Mailing Address - Zip Code:13473-2105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5429 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:TURIN
Practice Address - State:NY
Practice Address - Zip Code:13473-2105
Practice Address - Country:US
Practice Address - Phone:315-335-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302172-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse