Provider Demographics
NPI:1073353298
Name:GRIMES, JAMIE MICHELLE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1493
Mailing Address - Street 2:
Mailing Address - City:ROUND MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89045-1493
Mailing Address - Country:US
Mailing Address - Phone:775-375-7170
Mailing Address - Fax:
Practice Address - Street 1:61 HADLEY CIR
Practice Address - Street 2:
Practice Address - City:ROUND MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89045-9674
Practice Address - Country:US
Practice Address - Phone:775-375-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker