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General NPI Number Information
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NPI Number | 1003009705
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Entity Type | Individual
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Provider Name | SERENA DAWN WOODS-GRIMM M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/26/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 201 N CENTRAL AVE
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City | PHOENIX
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State | AZ
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Zip | 85004-8001
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Country | US
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Telephone | 602-221-6326
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Fax |
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Provider Business Mailing Address
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Address Line | 7113 W SUPERIOR AVE
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City | PHOENIX
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State | AZ
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Zip | 85043-7293
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Country | US
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Telephone | 623-210-1150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37116
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License Number State | AZ
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