Provider Demographics
NPI:1053680637
Name:GRIMM, JASON ALAN (STNA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALAN
Last Name:GRIMM
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 LEXVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2916
Mailing Address - Country:US
Mailing Address - Phone:234-567-7082
Mailing Address - Fax:
Practice Address - Street 1:1766 LEXVIEW CIR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2916
Practice Address - Country:US
Practice Address - Phone:234-567-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide