Healthcare Provider Details

I. General information

NPI: 1285881979
Provider Name (Legal Business Name): CATHERINE DIGILIO GRIMES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 14TH ST SCHOOL NUTRITION PROGRAMS DEPARTMENT OF EDUCATION
RICHMOND VA
23219-3665
US

IV. Provider business mailing address

101 N 14TH ST SCHOOL NUTRITION PROGRAMS DEPARTMENT OF EDUCATION
RICHMOND VA
23219-3665
US

V. Phone/Fax

Practice location:
  • Phone: 804-225-2074
  • Fax: 804-786-3117
Mailing address:
  • Phone: 804-225-2074
  • Fax: 804-786-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberB00134
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberB00134
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: