Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | OR |
NPI | 1255950275 |
---|---|
Provider Name | Amiee Michele Grimes I |
First Address | Klamath Falls, OR 97603-2612 |
Second Address | Klamath Falls, OR 97603-2612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 09/04/2020 |