Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | COA.17708-NP | OH |
NPI | 1013397702 |
---|---|
Provider Name | Emily Marie Grimm |
First Address | Cleveland, OH 44114-2910 |
Second Address | Cleveland, OH 44114-2910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2015 |
Last Update Date | 14/11/2018 |