Provider Demographics
NPI:1932580875
Name:GROME, BRITTANY (LPN)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:GROME
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6349B HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13603-2057
Mailing Address - Country:US
Mailing Address - Phone:910-633-2153
Mailing Address - Fax:
Practice Address - Street 1:6349B HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13603-2057
Practice Address - Country:US
Practice Address - Phone:910-633-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296932164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse