Individual
GLYNDA KISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OFFICE COORDINATOR
Contact information
Practice address
302 E LINDEN AVE STE 103, COEUR D ALENE, ID 83814-6177
(208) 415-0366
(208) 625-2000
Mailing address
302 E LINDEN AVE STE 103, COEUR D ALENE, ID 83814-6177
(208) 415-0366
(208) 625-2000
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
372600000X
Adult Companion
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
HOME CARE
ID
Enumeration date
05/19/2022
Last updated
10/17/2022
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