Individual
ANNA KATHLEEN GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-1303
(503) 346-8021
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-1303
(503) 346-8021
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
201501103NP-PP
OR
363LA2100X
Acute Care Nurse Practitioner
COA.03700-NP
OH
363LF0000X
Family Nurse Practitioner
201501120NP-PP
OR
363LF0000X
Family Nurse Practitioner
33115
WV
363LF0000X
Family Nurse Practitioner
COA.03700-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0051782
—
OH
01
—
1067391
WV WORK COMP
WV
05
—
3810001991
—
WV
Enumeration date
06/12/2006
Last updated
06/21/2016
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