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NPI Code Detail

MEDICARE: PROF. JEANNE MARIE GRIMES CRNA

MEDICARE: PROF. JEANNE MARIE GRIMES CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistRN521925LPA
2367500000XCertified Registered Nurse Anesthetist56444WV

General Provider Information

NPI Number : 1245203140
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. JEANNE MARIE GRIMES CRNA
Provider Business Mailing Address
First Line : PO BOX 780
Second Line :
City : MORGANTOWN
State : WV
Zip : 26507-0780
Country : US
Telephone Number : 304-293-7401
Fax Number :
Provider Business Practice Location Address
First Line : 101 STADIUM DR
Second Line :
City : MORGANTOWN
State : WV
Zip : 26506-7911
Country : US
Telephone Number : 304-598-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 11/16/2011

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Directions to “ PROF. JEANNE MARIE GRIMES CRNA” Practice Location

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