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General NPI Number Information
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NPI Number | 1306543103
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Entity Type | Individual
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Provider Name | JESSELYN GRIMSHAW
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Gender | Female
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 3600 30TH ST
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City | DES MOINES
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State | IA
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Zip | 50310-5753
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Country | US
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Telephone | 515-699-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 WALL AVE
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City | DES MOINES
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State | IA
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Zip | 50315-5066
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Country | US
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Telephone | 515-509-4533
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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