Healthcare Provider Details

I. General information

NPI: 1609770429
Provider Name (Legal Business Name): MEGHAN GRIMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

8016 S 60TH ST
FRANKLIN WI
53132-9259
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03260615
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: