Provider Demographics
NPI:1982059838
Name:GRIMM, ANNMARIE (RN)
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:GRIMM
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 1:1543 TOD AVE, SW
Mailing Address - Street 2:JEFFERSON PK-8 SCHOOL
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485
Mailing Address - Country:US
Mailing Address - Phone:330-675-6960
Mailing Address - Fax:330-675-6961
Practice Address - Street 1:1543 TOD AVE SW
Practice Address - Street 2:JEFFERSON SCHOOL PK-8
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485
Practice Address - Country:US
Practice Address - Phone:330-675-6960
Practice Address - Fax:330-675-6961
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21128909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHIRN009112Medicaid