Individual
MRS. TERESA G GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
132 HOSPITAL DR, WATERTOWN, WI 53098-3304
(920) 261-2020
(920) 261-0457
Mailing address
N6480 SHOREWOOD MEADOWS DR, LAKE MILLS, WI 53551-9730
(920) 648-4380
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
994-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41958600
—
WI
Enumeration date
01/04/2007
Last updated
07/08/2007
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