Provider Demographics
NPI:1225430929
Name:GRIMMER, CAROL R (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:R
Last Name:GRIMMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26750 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1211
Mailing Address - Country:US
Mailing Address - Phone:248-465-4782
Mailing Address - Fax:
Practice Address - Street 1:26750 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1211
Practice Address - Country:US
Practice Address - Phone:248-465-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704148154363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care