Provider Demographics
NPI:1427941335
Name:GRIMALDI, ROBERT S SR (LPN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:GRIMALDI
Suffix:SR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:ROCKY TOP
Mailing Address - State:TN
Mailing Address - Zip Code:37769-0656
Mailing Address - Country:US
Mailing Address - Phone:865-356-7628
Mailing Address - Fax:
Practice Address - Street 1:815 E CHURCHWELL AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4409
Practice Address - Country:US
Practice Address - Phone:865-356-7628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46788164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse