Individual
MRS. LISA ANNE GROOMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4532 PLANK RD, FREDERICKSBURG, VA 22407-0139
(540) 252-1840
(540) 252-1841
Mailing address
4532 PLANK RD, FREDERICKSBURG, VA 22407-0139
(540) 252-1840
(540) 252-1841
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002015
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821018219
—
VA
01
—
540896390
TRICARE
VA
Enumeration date
07/20/2006
Last updated
11/28/2017
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