Healthcare Provider Details

I. General information

NPI: 1770693632
Provider Name (Legal Business Name): MELISSA S GRIMM RN, CNS, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN ST
AKRON OH
44310-3110
US

IV. Provider business mailing address

6111 WICLIF ST NE
CANTON OH
44721-3648
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-9599
  • Fax:
Mailing address:
  • Phone: 330-327-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN 211730
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPRN.CNS.08535
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: