MEDICARE: MRS. PATRICIA JEAN GRIMM R.N.

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
1	163WH0200X	Home Health Registered Nurse		WI

General Provider Information

NPI Number	:	1578785226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA JEAN GRIMM R.N.

Provider Business Mailing Address
First Line	:	27375 BARNETT LN
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-9000
Country	:	US
Telephone Number	:	608-647-6835
Fax Number	:

Provider Business Practice Location Address
First Line	:	27375 BARNETT LN
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-9000
Country	:	US
Telephone Number	:	608-647-6835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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