Provider Demographics
NPI:1619694395
Name:GRIMES, JOHANNA MARIE (LM)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9742 NARROW GAUGE RD
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:MI
Mailing Address - Zip Code:49617-9770
Mailing Address - Country:US
Mailing Address - Phone:517-648-4102
Mailing Address - Fax:231-284-2030
Practice Address - Street 1:5885 FRANKFORT HWY
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9525
Practice Address - Country:US
Practice Address - Phone:517-648-4102
Practice Address - Fax:231-284-2030
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000102176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife