Provider Demographics
NPI:1902407588
Name:GRIMMETT, AMANDA GAIL
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:GRIMMETT
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 1:10 PEACEFUL LANE
Mailing Address - Street 2:
Mailing Address - City:ACCOVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25606
Mailing Address - Country:US
Mailing Address - Phone:304-687-3622
Mailing Address - Fax:
Practice Address - Street 1:10 PEACEFUL LANE
Practice Address - Street 2:
Practice Address - City:ACCOVILLE
Practice Address - State:WV
Practice Address - Zip Code:25606
Practice Address - Country:US
Practice Address - Phone:304-687-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant