Individual
VALERI GRAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
8971 W OVERLAND RD, BOISE, ID 83709-1651
(208) 378-4288
(208) 378-4297
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6522
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1220
ID
363AM0700X
Medical Physician Assistant
0003782
CO
363AS0400X
Surgical Physician Assistant
0003782
CO
Other
Enumeration date
09/19/2013
Last updated
12/16/2016
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