Healthcare Provider Details

I. General information

NPI: 1598721110
Provider Name (Legal Business Name): CYNTHIA ANN GRIMES NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E WILLETTA ST RM 3305
PHOENIX AZ
85006-2727
US

IV. Provider business mailing address

9402 N 36TH AVE
PHOENIX AZ
85051-3305
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-2635
  • Fax: 602-239-2307
Mailing address:
  • Phone: 602-973-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number68
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: