Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 110569 | NE |
NPI | 1275753683 |
---|---|
Provider Name | Ms. Kim M Grimm |
First Address | Omaha, NE 68103-2797 |
Second Address | Omaha, NE 68114-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 13/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100258661-00 | (05) | NE |
1275753683 | (05) | IA |