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General NPI Number Information
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NPI Number | 1023816766
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Entity Type | Individual
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Provider Name | ANDREA NICOLE GRIMES CST, CSFA
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Gender | Female
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1227 BALTIMORE ST
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City | HANOVER
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State | PA
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Zip | 17331-4406
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Country | US
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Telephone | 717-356-4845
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Fax |
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Provider Business Mailing Address
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Address Line | 124 E DEEP RUN RD
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City | WESTMINSTER
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State | MD
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Zip | 21158-2208
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Country | US
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Telephone | 717-250-2868
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 206291
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License Number State | PA
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