NICHOLE SUZANNE GRIMM (NPI# 1669756813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669756813 |
| Entity Type | Individual |
| Full Name | NICHOLE SUZANNE GRIMM |
| Credential | NP |
| Practice Address |
30544 Highway 200 Ste 101 Ponderay ID 83852-5005 |
| Mailing Address |
30544 Highway 200 Ste 102 Ponderay ID 83852-5005 |
| Practice Telephone | 2082636300 |
| Practice Fax Number | 2082636355 |
| Mailing Telephone | 2082636300 |
| Mailing Fax Number | 2082636355 |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2016-12-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
NP-1113A | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
30544 HIGHWAY 200 STE 101 |
| City | PONDERAY |
| State | ID |
| Zip Code | 83852-5005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780651539 | Bruce William Demko | Nurse Anesthetist, Certified Registered | 30544 Highway 200, Ponderay, ID 83852-5005 | 2006-03-01 |
| 1679110845 | Angela Alice Chapin | Massage Therapist | 30544 Highway 200, Ponderay, ID 83852-5005 | 2019-12-05 |
| 1851894018 | Jessica Hunt | Massage Therapist | 30544 Highway 200, Ponderay, ID 83852-5005 | 2018-03-14 |
| 1235649625 | Kauai In-home Therapy LLC | Clinic/Center | 30544 Highway 200, Ponderay, ID 83852-5005 | 2017-10-11 |
| 1932527389 | Stuart Gall Crna Inc | Nurse Anesthetist, Certified Registered | 30544 Highway 200, Suite 201, Ponderay, ID 83852-5005 | 2014-04-02 |
| 1073757464 | Michael R Dibenedetto Md Pllc | Surgery | 30544 Highway 200, Suite 102, Ponderay, ID 83852-5005 | 2009-04-29 |
| 1891969606 | Jonathan Donald Fisher | Podiatrist | 30544 Highway 200, Suite 102, Ponderay, ID 83852-5005 | 2008-04-14 |
| 1376713008 | Bruce Demko Crna Inc | Nurse Anesthetist, Certified Registered | 30544 Highway 200, Ponderay, ID 83852-5005 | 2008-03-10 |
| 1821276353 | Pend Oreille Surgery Center LLC | Clinic/Center | 30544 Highway 200, Suite 201, Ponderay, ID 83852-5005 | 2008-02-06 |
| 1679644397 | Michael Raymond Dibenedetto | Orthopaedic Surgery | 30544 Highway 200, Ste 102, Ponderay, ID 83852-5005 | 2006-11-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346606647 | Vern Stairs | Pharmacist | 476999 Us-95, Walmart Supercenter, Ponderay, ID 83852 | 2016-01-04 |
| 1083809727 | Michael R Dibenedetto Md Pllc | Orthopaedic Surgery | 30544 Hwy 200, Ste 102, Ponderay, ID 83852 | 2007-09-06 |
| 1811009988 | David Paul Cox | Dentist | 477542 Hwy 95 N, Ponderay, ID 83852 | 2006-08-31 |
| 1861774291 | Michael David Schicker | Orthopaedic Surgery | 30544 Highway 200 Ste 102, Ponderay, ID 83852 | 2011-09-12 |
| 1750410825 | Glacier Prosthetic Care, Inc. | Prosthetic/Orthotic Supplier | 205 Vermeer Dr, Suite C, Ponderay, ID 83852-1660 | 2007-03-05 |
| 1083949531 | Mario E Roxas | Naturopath | 476864 Highway 95, Suite #3, Ponderay, ID 83852-5000 | 2009-10-15 |
| 1942716246 | Darwin L Hurst | Family Medicine | 30544 Highway 200 Ste 101, Ponderay, ID 83852-5005 | 2017-12-21 |
| 1902036734 | Innovative Anesthesia | Nurse Anesthetist, Certified Registered | 30544 Highway 200 Ste 201, Pend Oreille Surgery Center, Ponderay, ID 83852-5005 | 2009-07-14 |
| 1255597811 | Travis Lee Taylor | Nurse Practitioner | 30544 Highway 200 Ste 102, Ponderay, ID 83852-5005 | 2008-08-04 |
| 1982741195 | Ryan Leisy | Chiropractor | 30544 Highway 200 Ste 330, Ponderay, ID 83852-5005 | 2007-01-30 |
| Find all providers in zip 83852 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932758083 | Graham Charles Andrews | Nurse Practitioner | 400 Schweitzer Plaza Dr Ste 1, Ponderay, ID 83852-9819 | 2019-09-10 |
| 1255597811 | Travis Lee Taylor | Nurse Practitioner | 30544 Highway 200 Ste 102, Ponderay, ID 83852-5005 | 2008-08-04 |
| 1821003708 | Ammara, Inc. | Nurse Practitioner | 30410 Highway 200, Ponderay, ID 83852-9601 | 2006-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104427152 | Christopher Alan Anthony Nicholas | Nurse Practitioner | 2889 N Chancery Pl, Meridian, ID 83646-7407 | 2020-11-05 |
| 1710588108 | Lauren Proteau | Nurse Practitioner | 310 S Acer Loop, Post Falls, ID 83854-8809 | 2020-11-03 |
| 1568061398 | Nicolette A Eberline | Nurse Practitioner | 4228 W Guard St Bldg 665, Boise, ID 83705-8049 | 2020-10-22 |
| 1023617347 | Kristina Oliver | Nurse Practitioner | 980 W Ironwood Dr Ste 302, Coeur D Alene, ID 83814-2668 | 2020-10-19 |
| 1730787482 | John Dustin Pena | Nurse Practitioner | 102 Courthouse Dr Ste F, Salmon, ID 83467-3905 | 2020-10-14 |
| 1982202743 | Jayson Paul Smith | Nurse Practitioner | 1545 East Leighfield Dr., Meridian, ID 83646 | 2020-10-14 |
| 1659979516 | Jennifer Anne Gardner | Nurse Practitioner | 1385 Park View Dr Ste 101, Twin Falls, ID 83301-4390 | 2020-10-13 |
| 1982210795 | Samuel Hally | Nurse Practitioner | 1346 Cimarron Ct, Middleton, ID 83644-5894 | 2020-09-17 |
| 1013522275 | Beau Lee | Nurse Practitioner | 2900 N Burton St, Boise, ID 83704-5314 | 2020-09-14 |
| 1649885534 | Auston Whitmer | Nurse Practitioner | 2203 E Ringneck St, Meridian, ID 83646-7410 | 2020-09-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.