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NPI Code Detail

MEDICARE: MS. CRYSTAL GRIMES NP

MEDICARE:  MS. CRYSTAL  GRIMES  NP
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
1363LW0102XWomen's Health Nurse PractitionerRN265816MA

General Provider Information

NPI Number : 1699135657
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CRYSTAL GRIMES NP
Provider Business Mailing Address
First Line : 280 BEACH ST
Second Line :
City : REVERE
State : MA
Zip : 02151-3143
Country : US
Telephone Number : 781-289-2266
Fax Number : 781-289-6993
Provider Business Practice Location Address
First Line : 280 BEACH ST
Second Line :
City : REVERE
State : MA
Zip : 02151-3143
Country : US
Telephone Number : 781-289-2266
Fax Number : 781-289-6993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2016
Last Update Date : 03/03/2016

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