Provider Demographics
NPI:1285952689
Name:GRYMES, NELDA J (RN)
Entity type:Individual
Prefix:
First Name:NELDA
Middle Name:J
Last Name:GRYMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NW BEAVER ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 NW BEAVER ST
Practice Address - Street 2:STE. 100
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1802
Practice Address - Country:US
Practice Address - Phone:541-447-5165
Practice Address - Fax:541-447-3093
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200041175RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse