Healthcare Provider Details

I. General information

NPI: 1235530064
Provider Name (Legal Business Name): CASSANDRA LYNN GRIMES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 DISCOVERY DR STE 210
LANSING MI
48910-8609
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 517-484-0004
  • Fax: 616-267-2201
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704226428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: