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NPI Code Detail

MEDICARE: JESSICA LEIGH GRIM FNP

MEDICARE: JESSICA LEIGH GRIM FNP
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
1363LF0000XFamily Nurse Practitioner10021457OR

General Provider Information

NPI Number : 1568225738
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LEIGH GRIM FNP
Provider Business Mailing Address
First Line : 41350 SUNSET WAY SE
Second Line :
City : STAYTON
State : OR
Zip : 97383-9710
Country : US
Telephone Number : 503-560-2859
Fax Number :
Provider Business Practice Location Address
First Line : 280 S 1ST AVE
Second Line :
City : MILL CITY
State : OR
Zip : 97360-2324
Country : US
Telephone Number : 503-897-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2024
Last Update Date : 08/22/2024

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