Individual
AMANDA RENEE' GROOMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 1ST AVE, WAVERLY, OH 45690-1101
(740) 708-3920
Mailing address
102 1ST AVE, WAVERLY, OH 45690-1101
(740) 708-3920
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.126849IV
OH
Other
Enumeration date
11/16/2012
Last updated
11/16/2012
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