Provider Demographics
NPI:1811386170
Name:GRIMM, ANGELA (LPN179520MEDS-IV)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LPN179520MEDS-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 HOPEWELL RD N
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43746-9755
Mailing Address - Country:US
Mailing Address - Phone:740-624-0040
Mailing Address - Fax:
Practice Address - Street 1:55 BEECH ROCK DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6303
Practice Address - Country:US
Practice Address - Phone:740-624-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04816224Z00000X
OHLPN.179520.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant