Provider Demographics
NPI:1245462027
Name:GRIMSTAD, JULIE DIANE (NP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:DIANE
Last Name:GRIMSTAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:DIANE
Other - Last Name:GRIMSTAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:172 KINSLEY ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3648
Mailing Address - Country:US
Mailing Address - Phone:603-595-3165
Mailing Address - Fax:603-595-3192
Practice Address - Street 1:172 KINSLEY ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3648
Practice Address - Country:US
Practice Address - Phone:603-595-3165
Practice Address - Fax:603-595-3192
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA691531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS853WMedicare PIN
CACS853ZMedicare PIN
CACS853AMedicare PIN
CACS853YMedicare PIN
CACS853XMedicare PIN