Provider Demographics
NPI:1093195836
Name:GRIMES, MONICA (LVN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18510 KYACK CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2884
Mailing Address - Country:US
Mailing Address - Phone:832-412-6674
Mailing Address - Fax:
Practice Address - Street 1:18510 KYACK CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2884
Practice Address - Country:US
Practice Address - Phone:832-412-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166045164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204424660OtherGRIMES SENIOR CARE SERVICES