Provider Demographics
NPI:1215575436
Name:GRIMM, CAROL S (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:S
Last Name:GRIMM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5702 BRIDGETOWN RD APT 8
Mailing Address - Street 2:STREET ADDRESS 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248
Mailing Address - Country:US
Mailing Address - Phone:513-479-8863
Mailing Address - Fax:
Practice Address - Street 1:CLINIC #3301 28100 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:WOODMIRE
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-831-1466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily