Provider Demographics
NPI:1427587906
Name:GROOMS, LISA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:NICOLE
Last Name:GROOMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:NICOLE
Other - Last Name:FINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0485
Mailing Address - Country:US
Mailing Address - Phone:765-599-3100
Mailing Address - Fax:765-518-5365
Practice Address - Street 1:152 WITTENBRAKER AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-5000
Practice Address - Country:US
Practice Address - Phone:765-599-3100
Practice Address - Fax:765-518-5365
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083214A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine