Provider Demographics
NPI:1720977408
Name:GRIMES, ANNA LINNEA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LINNEA
Last Name:GRIMES
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 1:9761 N FEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9091
Mailing Address - Country:US
Mailing Address - Phone:801-361-6179
Mailing Address - Fax:
Practice Address - Street 1:9761 N FEATHERSTONE DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9091
Practice Address - Country:US
Practice Address - Phone:801-361-6179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT95216664405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics