Provider Demographics
NPI:1982181061
Name:GRIMSLEY, MEGAN ANASTASIA (CNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANASTASIA
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANASTASIA
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1820
Mailing Address - Country:US
Mailing Address - Phone:320-634-5157
Mailing Address - Fax:320-634-2244
Practice Address - Street 1:600 PETERSON PKWY
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273-7823
Practice Address - Country:US
Practice Address - Phone:320-354-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCNP6003OtherMN BOARD OF NURSING APRN LICENSE