Healthcare Provider Details

I. General information

NPI: 1093632382
Provider Name (Legal Business Name): ADAM ALEXANDER GRIMSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 WINNIPEG DR
BISMARCK ND
58503-0451
US

IV. Provider business mailing address

3140 WINNIPEG DR
BISMARCK ND
58503-0451
US

V. Phone/Fax

Practice location:
  • Phone: 701-260-4519
  • Fax:
Mailing address:
  • Phone: 701-260-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number205113
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: