Provider Demographics
NPI:1649924234
Name:GRIMM, MEREDITH KAY (NTP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:KAY
Last Name:GRIMM
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6975 E PRINCESS DR APT 1016
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4209
Mailing Address - Country:US
Mailing Address - Phone:417-812-9223
Mailing Address - Fax:
Practice Address - Street 1:6975 E PRINCESS DR APT 1016
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-4209
Practice Address - Country:US
Practice Address - Phone:417-812-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR871133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist