Healthcare Provider Details

I. General information

NPI: 1104199843
Provider Name (Legal Business Name): NICOLE LEE GRIMM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE LEE PIOTROWSKI RN

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 VERN HOLMES DR
STEVENS POINT WI
54482-8853
US

IV. Provider business mailing address

5409 VERN HOLMES DR
STEVENS POINT WI
54482-8853
US

V. Phone/Fax

Practice location:
  • Phone: 715-342-1185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7803-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number7803-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number184270-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: