Individual
GUSS GRIMMETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1441 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-2600
Mailing address
1441 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-2600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-651
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806949500
—
ID
Enumeration date
06/23/2006
Last updated
04/13/2017
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