Basic Information
| Provider Information | |||||||||
| NPI: | 1396745709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIM | ||||||||
| FirstName: | LORNA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 711052 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452710001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144578180 | ||||||||
| FaxNumber: | 6145833300 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148986659 | ||||||||
| FaxNumber: | 6148988631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | COA.00261-NA | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 2058259 | 05 | OH | MEDICAID |