Individual
AMANDA LEE GROOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
255 ENTERPRISE BLVD, SUITE 101, GREENVILLE, SC 29615-6300
(864) 454-8120
(864) 454-8125
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6328
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
19644
SC
363LP2300X
Primary Care Nurse Practitioner
Primary
19644
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3381
—
SC
Enumeration date
10/27/2010
Last updated
11/30/2021
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