Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP60669354 | WA |
NPI | 1548710551 |
---|---|
Provider Name | Mrs. Vicki Lynn Grimes |
First Address | Tacoma, WA 98408-3037 |
Second Address | Tacoma, WA 98405-3926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2016 |
Last Update Date | 13/10/2016 |