Individual
MRS. TONIA C GRANTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1393
Mailing address
1408 W BLAINE AVE, NAMPA, ID 83651-7676
(208) 466-8758
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
9888
ID
Other
Enumeration date
06/02/2008
Last updated
06/02/2008
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