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NPI Code Detail

MEDICARE: BONNIE GRIMES NP

MEDICARE: BONNIE GRIMES NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerVA

General Provider Information

NPI Number : 1336161462
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE GRIMES NP
Provider Business Mailing Address
First Line : 1431 CENTERPOINT BLVD
Second Line : SUITE 100
City : KNOXVILLE
State : TN
Zip : 37932-1984
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2 BERNARDINE DR
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23602-4404
Country : US
Telephone Number : 757-886-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 07/08/2007

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