1033494760 NPI number — MS. LORI ANN GRIMES MAC,LAC,MBA

Table of content: MS. LORI ANN GRIMES MAC,LAC,MBA (NPI 1033494760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033494760 NPI number — MS. LORI ANN GRIMES MAC,LAC,MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIMES
Provider First Name:
LORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MAC,LAC,MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIMES
Provider Other First Name:
LORI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAC, LAC, MBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033494760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7937 TRALEE CT
Provider Second Line Business Mailing Address:
LAUREL
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20723-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-257-0414
Provider Business Mailing Address Fax Number:
301-776-1499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5570 STERRETT PL
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-257-0414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  UO1924 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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