Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201506662NP-PP | OR |
N | 363LF0000X | Nurse Practitioner - Family Medicine | A125704 | IA |
NPI | 1003225525 |
---|---|
Provider Name | Heidi Lee Grimes |
First Address | Corvallis, OR 97339-1193 |
Second Address | Lebanon, OR 97355-4361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2014 |
Last Update Date | 18/02/2021 |