Individual
ARIELLE GRIMMAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 W 2ND ST, EAST SYRACUSE, NY 13057-2803
(315) 901-1943
Mailing address
107 W 2ND ST, EAST SYRACUSE, NY 13057-2803
(315) 901-1943
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
323556
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370483695
DRIVERS LICENSE
NY
Enumeration date
01/09/2022
Last updated
07/21/2022
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