Individual
PATTY J ACKERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, CNM, APRN
Contact information
Practice address
804 S MAIN ST, GRACE, ID 83241-4712
(208) 220-7111
(208) 269-1491
Mailing address
804 S MAIN ST, GRACE, ID 83241-4712
(208) 220-7111
(208) 269-1491
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
CMN61A
ID
363L00000X
Nurse Practitioner
CMN61A
ID
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Enumeration date
09/13/2011
Last updated
05/08/2025
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