Individual
CHRISTINA R GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3504 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(765) 453-6600
(765) 865-6606
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003394
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201112780
—
IN
01
—
P01270923
RR MEDICARE
IN
Enumeration date
09/24/2010
Last updated
11/27/2023
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