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Individual

MS. GRACE SUYANTI MULIAWAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3815 N SCHREIBER WAY STE 101, COEUR D ALENE, ID 83815-8362
(208) 755-2804
(208) 765-0277
Mailing address
3815 N SCHREIBER WAY STE 101, COEUR D ALENE, ID 83815-8362
(208) 755-2804
(208) 765-0277

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1991
ID
363AM0700X
Medical Physician Assistant
PA-1991
ID

Other

Enumeration date
10/17/2020
Last updated
08/25/2023
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