Provider Demographics
NPI:1407945694
Name:GRIMES, MIKI N (NP)
Entity Type:Individual
Prefix:
First Name:MIKI
Middle Name:N
Last Name:GRIMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64-1035 MAMALAHOA HWY, SUITE K
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96738
Mailing Address - Country:US
Mailing Address - Phone:808-885-9647
Mailing Address - Fax:808-885-9647
Practice Address - Street 1:64-1035 MAMALAHOA HWY STE K
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8440
Practice Address - Country:US
Practice Address - Phone:808-885-9647
Practice Address - Fax:808-885-9647
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN34158163W00000X
HIAPRN258363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52191501Medicaid