Healthcare Provider Details

I. General information

NPI: 1477461697
Provider Name (Legal Business Name): NATALIE GRABELKOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 W USTICK RD STE 110
MERIDIAN ID
83646-7740
US

IV. Provider business mailing address

1510 W USTICK RD STE 110
MERIDIAN ID
83646-7740
US

V. Phone/Fax

Practice location:
  • Phone: 208-941-3146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5781306
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: