Provider Demographics
NPI:1912675885
Name:GRIMM, MADELINE RAE (RDN)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:RAE
Last Name:GRIMM
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 PORTLAND AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3610
Mailing Address - Country:US
Mailing Address - Phone:815-302-8587
Mailing Address - Fax:
Practice Address - Street 1:7002 CHADWICK DR
Practice Address - Street 2:UNIT 330
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37037
Practice Address - Country:US
Practice Address - Phone:615-465-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered