| NPI | 1184126732 |
|---|---|
| Former Name | SHEILA RAE GRIMM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-006837) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 1033220314) |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2019-12-19 |