Provider Demographics
NPI:1184280273
Name:GROOMS, JERONDA (CNA)
Entity type:Individual
Prefix:
First Name:JERONDA
Middle Name:
Last Name:GROOMS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SALINA ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-2910
Mailing Address - Country:US
Mailing Address - Phone:585-351-9783
Mailing Address - Fax:
Practice Address - Street 1:66 SALINA ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2910
Practice Address - Country:US
Practice Address - Phone:585-351-9783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide