Provider Demographics
NPI:1306485008
Name:GRIMM, CRESENCIA ANCHETA (MSNNHCECPANACNPCAG)
Entity type:Individual
Prefix:
First Name:CRESENCIA
Middle Name:ANCHETA
Last Name:GRIMM
Suffix:
Gender:F
Credentials:MSNNHCECPANACNPCAG
Other - Prefix:
Other - First Name:CRESENCIA
Other - Middle Name:PASTORES
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 E SADDLE LN
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2938
Mailing Address - Country:US
Mailing Address - Phone:252-646-4820
Mailing Address - Fax:
Practice Address - Street 1:511 PALADIN DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7826
Practice Address - Country:US
Practice Address - Phone:252-752-8880
Practice Address - Fax:252-317-2092
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012647363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care