Provider Demographics
NPI:1790301588
Name:GRIMM, ANNE (DTR)
Entity Type:Individual
Prefix:MISS
First Name:ANNE
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 E TORREY PINES LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7157
Mailing Address - Country:US
Mailing Address - Phone:330-313-1551
Mailing Address - Fax:
Practice Address - Street 1:4313 E TORREY PINES LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-7157
Practice Address - Country:US
Practice Address - Phone:330-313-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered