Individual
KELLI ANN GRAMBEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
110 E WALLACE AVE, COEUR D ALENE, ID 83814-2948
(208) 853-0707
Mailing address
519 S 11TH ST, COEUR D ALENE, ID 83814-3805
(904) 307-9195
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
60645
ID
Other
Enumeration date
05/12/2020
Last updated
05/12/2020
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