Individual
TAYLORE MARIE GRIMM
Active
Individual
TAYLORE MARIE GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
3397
TN
363AS0400X
Surgical Physician Assistant
Primary
3397
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3397
STATE LICENSE NUMBER
TN
Enumeration date
10/23/2017
Last updated
06/16/2018
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