Doctor Name: | HANA GRIMM |
NPI Number: | 1831463751 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, NP |
License Number: | 22474 |
Business Practice Address: | 7219 N Litchfield Rd 56 Medical Group Luke Afb, AZ - 853091529 |
Business Phone Number: | 6238567982 |
Business Fax Number: | |
Mailing Address: | 7219 N Litchfield Rd, 56 Medical Group LUKE AFB |
State: | AZ |
Postal Code: | 853091529 |
Phone Number: | 6238567982 |
Fax Number: | |
NPI Enumeration Date: | 02/24/2012 |
NPI Last Update Date: | 08/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 22474 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |