Healthcare Provider Details

I. General information

NPI: 1255170478
Provider Name (Legal Business Name): HALEIGH N GROOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SAINT CLAIR RIVER DR
ALGONAC MI
48001-1802
US

IV. Provider business mailing address

555 SAINT CLAIR RIVER DR
ALGONAC MI
48001-1802
US

V. Phone/Fax

Practice location:
  • Phone: 810-794-4917
  • Fax:
Mailing address:
  • Phone: 586-295-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704343085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: