Healthcare Provider Details

I. General information

NPI: 1629029921
Provider Name (Legal Business Name): FAYE GRIMMELL ANP/GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 SW PACIFIC HWY
TIGARD OR
97223
US

IV. Provider business mailing address

6 CENTERPOINTE DR STE 200
LAKE OSWEGO OR
97035-8660
US

V. Phone/Fax

Practice location:
  • Phone: 503-598-2000
  • Fax: 503-639-0920
Mailing address:
  • Phone: 503-797-2273
  • Fax: 503-234-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number081001262N3
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: