Individual
COURTNEY ANN GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
169 RIVERSIDE DR, BINGHAMTON, NY 13905-4198
(607) 798-5100
Mailing address
8970 MAIN ST, LISLE, NY 13797-1204
(607) 435-6612
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
645445
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F309184-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10312015
—
NY
Enumeration date
04/04/2019
Last updated
08/20/2019
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