Provider Demographics
NPI:1861188294
Name:GRIMM, AUDREY (ARNP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 S KAYLA CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-0017
Mailing Address - Country:US
Mailing Address - Phone:208-797-6262
Mailing Address - Fax:
Practice Address - Street 1:10305 E MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4220
Practice Address - Country:US
Practice Address - Phone:509-418-2108
Practice Address - Fax:509-315-9386
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60962877163WP0808X
WAAP61505608363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health