Provider Demographics
NPI:1255037263
Name:GRIM, WENDY P (APRN-FNP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:P
Last Name:GRIM
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 OLD CABIN TRL
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59749-9000
Mailing Address - Country:US
Mailing Address - Phone:208-681-8288
Mailing Address - Fax:
Practice Address - Street 1:41 BARRETT ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3508
Practice Address - Country:US
Practice Address - Phone:406-683-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT212533363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner