MEDICARE: MRS. SHERRY SUZANNE GROOMS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	263353	OH

General Provider Information

NPI Number	:	1528043106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRY SUZANNE GROOMS NP

Provider Business Mailing Address
First Line	:	6021 DAYTON RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45502-9163
Country	:	US
Telephone Number	:	937-864-0503
Fax Number	:

Provider Business Practice Location Address
First Line	:	3572 DAYTON XENIA RD
Second Line	:	SUITE 105
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2886
Country	:	US
Telephone Number	:	937-427-4600
Fax Number	:	937-427-4520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/08/2007

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