Provider Demographics
NPI:1073633913
Name:GRIMM, JOYCE ELIZABETH (GNP)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:ELIZABETH
Last Name:GRIMM
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15224 HAVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1933
Mailing Address - Country:US
Mailing Address - Phone:586-247-6279
Mailing Address - Fax:
Practice Address - Street 1:2567 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1235
Practice Address - Country:US
Practice Address - Phone:313-895-5340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704171005363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology