| NPI | 1447789565 |
|---|---|
| Former Name | JACKIE MAE GRIMES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 312232) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PA OT018082) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 312232) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2023-07-07 |