Provider Demographics
NPI:1538325659
Name:GRIMM, MADELENE L R (APN)
Entity Type:Individual
Prefix:
First Name:MADELENE
Middle Name:L R
Last Name:GRIMM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 GROSS POINT RD
Mailing Address - Street 2:PATIENT CARE SERVICES
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1214
Mailing Address - Country:US
Mailing Address - Phone:847-933-6091
Mailing Address - Fax:847-933-6058
Practice Address - Street 1:9600 GROSS POINT RD
Practice Address - Street 2:PATIENT CARE SERVICES
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1214
Practice Address - Country:US
Practice Address - Phone:847-933-6091
Practice Address - Fax:847-933-6058
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006830364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist