Provider Demographics
NPI:1083866032
Name:GRIMM, JASON W (ACNP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:W
Last Name:GRIMM
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AVIATOR CT STE 100B
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9474
Mailing Address - Country:US
Mailing Address - Phone:210-860-0626
Mailing Address - Fax:
Practice Address - Street 1:600 AVIATOR CT STE 100B
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9474
Practice Address - Country:US
Practice Address - Phone:210-860-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025146363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care