Individual
MRS. LARITA RAYE GRIMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 338-2345
Mailing address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71013930A
IN
363LP2300X
Primary Care Nurse Practitioner
71013930A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71013930A
APRN LICENSE
IN
Enumeration date
05/24/2023
Last updated
06/20/2023
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