Provider Demographics
NPI:1386921062
Name:GRIMES, VANESSA RAE (LM)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RAE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3294
Mailing Address - Country:US
Mailing Address - Phone:954-290-2679
Mailing Address - Fax:
Practice Address - Street 1:229 WILSON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3294
Practice Address - Country:US
Practice Address - Phone:954-290-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW254176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife