| NPI | 1235990904 |
|---|---|
| Former Name | JENNIFER KELLY GRIM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ 306679) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 306679) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2025-03-10 |