Individual
ANGELLA GRIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23115 125TH AVE, LAURELTON, NY 11413-1302
(718) 978-5304
Mailing address
23115 125TH AVE, LAURELTON, NY 11413-1302
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
402672-1
NY
Other
Enumeration date
09/15/2008
Last updated
09/15/2008
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