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General NPI Number Information
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NPI Number | 1407945694
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Entity Type | Individual
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Provider Name | MIKI N GRIMES NP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 64-1035 MAMALAHOA HWY STE K
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City | KAMUELA
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State | HI
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Zip | 96743-8440
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Country | US
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Telephone | 808-885-9647
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Fax | 808-885-9647
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Provider Business Mailing Address
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Address Line | 64-1035 MAMALAHOA HWY, SUITE K
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City | KAMUELA
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State | HI
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Zip | 96738
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Country | US
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Telephone | 808-885-9647
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Fax | 808-885-9647
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN34158
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN258
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License Number State | HI
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