Provider Demographics
NPI:1104469758
Name:GRIMMER, DEONNE
Entity type:Individual
Prefix:
First Name:DEONNE
Middle Name:
Last Name:GRIMMER
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 1:2308 ROGERS LN NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1007
Mailing Address - Country:US
Mailing Address - Phone:503-931-5279
Mailing Address - Fax:
Practice Address - Street 1:2308 ROGERS LN NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-1007
Practice Address - Country:US
Practice Address - Phone:503-931-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider