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General NPI Number Information
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NPI Number | 1538650890
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Entity Type | Individual
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Provider Name | HEATHER GRIMWOOD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 571 10TH ST
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City | NIAGARA FALLS
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State | NY
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Zip | 14301-1843
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Country | US
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Telephone | 716-278-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 5 LOWER CANADA DRIVE
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City | NIAGARA ON THE LAKE
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State | ONTARIO
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Zip | L0S1J0
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Country | CA
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 342963
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License Number State | NY
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