Provider Demographics
NPI:1558969832
Name:GRIMM, MARIAH LEANN
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:LEANN
Last Name:GRIMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 ADAMS AVE # A2
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2101
Mailing Address - Country:US
Mailing Address - Phone:304-376-1956
Mailing Address - Fax:
Practice Address - Street 1:449 ADAMS AVE # A2
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2101
Practice Address - Country:US
Practice Address - Phone:304-376-1956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant