Provider Demographics
NPI:1730684812
Name:GRIMALDO, LAKEN R (LVN)
Entity type:Individual
Prefix:
First Name:LAKEN
Middle Name:R
Last Name:GRIMALDO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 THELMA ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3974
Mailing Address - Country:US
Mailing Address - Phone:903-399-9144
Mailing Address - Fax:
Practice Address - Street 1:306 THELMA ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-3974
Practice Address - Country:US
Practice Address - Phone:903-399-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305036164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse