Individual
JENNIFER GRINAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
222 SOUTHWAY AVE STE C, LEWISTON, ID 83501-2703
(208) 792-0111
Mailing address
1200 NORA CREEK RD, TROY, ID 83871-9647
(208) 792-1011
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1175
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396151395
—
ID
05
—
1396151395
—
WA
Enumeration date
07/10/2014
Last updated
11/14/2024
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