Individual
MS. TERESA GRAKLANOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1618 S MILLENIUM WAY STE 100, MERIDIAN, ID 83642-6457
(208) 884-3376
(208) 884-0858
Mailing address
1618 S. MILLENNIUM WAY, SUITE 100, MERIDIAN, ID 83642-6457
(208) 884-3376
(208) 884-0858
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA393
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806410600
—
ID
Enumeration date
07/01/2006
Last updated
06/04/2025
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