Provider Demographics
NPI:1083594725
Name:GROOMS, VANESSA
Entity type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:
Last Name:GROOMS
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 1:19040 STATE ROUTE 41
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-8801
Mailing Address - Country:US
Mailing Address - Phone:937-217-2768
Mailing Address - Fax:
Practice Address - Street 1:19040 STATE ROUTE 41
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-8801
Practice Address - Country:US
Practice Address - Phone:937-217-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide