Individual
MICHAEL JAMES GRIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
5263 NE MARTIN LUTHER KING JR BLVD STE B, PORTLAND, OR 97211-3235
(312) 402-7004
Mailing address
122 RAINBOW DR # 2282, LIVINGSTON, TX 77399-1022
(312) 402-7004
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202210489NP
OR
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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