Basic Information
| Provider Information | |||||||||
| NPI: | 1184936908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIMM | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | EMILY | ||||||||
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| Credential: | LNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20925 PROFESSIONAL PLZ STE 230 | ||||||||
| Address2: | |||||||||
| City: | ASHBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201473403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036217121 | ||||||||
| FaxNumber: | 7036657686 | ||||||||
| Practice Location | |||||||||
| Address1: | 10521 ROSEHAVEN ST | ||||||||
| Address2: | SUITE LL 100 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220302837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032815000 | ||||||||
| FaxNumber: | 7032813491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2010 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 0024168872 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LX0001X | 0024168872 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.