Provider Demographics
NPI:1235767757
Name:GRIMES, CATHERINE NICOLE (RDN, LDN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:NICOLE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2133
Mailing Address - Country:US
Mailing Address - Phone:570-234-6885
Mailing Address - Fax:
Practice Address - Street 1:15 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2133
Practice Address - Country:US
Practice Address - Phone:570-234-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered