Provider Demographics
NPI:1023816766
Name:GRIMES, ANDREA NICOLE (CST, CSFA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:CST, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E DEEP RUN RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-2208
Mailing Address - Country:US
Mailing Address - Phone:717-250-2868
Mailing Address - Fax:
Practice Address - Street 1:1227 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-4406
Practice Address - Country:US
Practice Address - Phone:717-356-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA206291246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant