Provider Demographics
NPI:1104409788
Name:GRIMALDI, ANN (NURSE PRACTIONER)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LA RIVIERE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4344
Mailing Address - Country:US
Mailing Address - Phone:716-893-1010
Mailing Address - Fax:
Practice Address - Street 1:40 LA RIVIERE DR STE 140
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4306
Practice Address - Country:US
Practice Address - Phone:716-893-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310214363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health