Provider Demographics
NPI:1467590786
Name:WILLITS, LINDA GRIMM (RXN CNS)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:GRIMM
Last Name:WILLITS
Suffix:
Gender:F
Credentials:RXN CNS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON S
Mailing Address - Street 2:SUITE #1009
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3809
Mailing Address - Country:US
Mailing Address - Phone:303-759-2066
Mailing Address - Fax:303-759-0724
Practice Address - Street 1:1776 S JACKSON S
Practice Address - Street 2:SUITE #1009
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3809
Practice Address - Country:US
Practice Address - Phone:303-759-2066
Practice Address - Fax:303-759-0724
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60821364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MW0554611OtherDEA #