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General NPI Number Information
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NPI Number | 1285678060
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Entity Type | Individual
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Provider Name | KATHLEEN A GRIMM CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 23901 LAHSER RD
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City | SOUTHFIELD
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State | MI
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Zip | 48034-6035
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Country | US
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Telephone | 248-357-3360
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Fax | 248-357-0915
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Provider Business Mailing Address
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Address Line | 6684 MELDRUM RD
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City | FAIR HAVEN
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State | MI
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Zip | 48023-2001
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Country | US
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Telephone | 586-725-8062
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Fax | 248-357-0915
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704114284
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License Number State | MI
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