Provider Demographics
NPI:1851728406
Name:NOLAN GRIMES, MADISON (CDM, CPM)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:
Last Name:NOLAN GRIMES
Suffix:
Gender:F
Credentials:CDM, CPM
Other - Prefix:MS
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDM, CPM
Mailing Address - Street 1:1601 SALMON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7867
Mailing Address - Country:US
Mailing Address - Phone:907-586-1203
Mailing Address - Fax:907-586-5765
Practice Address - Street 1:1601 SALMON CREEK LN
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7867
Practice Address - Country:US
Practice Address - Phone:907-586-1203
Practice Address - Fax:907-586-5765
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK75176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife