Healthcare Provider Details

I. General information

NPI: 1710309588
Provider Name (Legal Business Name): KATHRYN GRAMLICH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 W REDDY WAY
BLOOMINGTON IN
47403-4066
US

IV. Provider business mailing address

3211 W REDDY WAY
BLOOMINGTON IN
47403-4066
US

V. Phone/Fax

Practice location:
  • Phone: 812-825-0777
  • Fax: 812-331-3311
Mailing address:
  • Phone: 812-825-0777
  • Fax: 812-331-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number28211746A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71004782A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004782
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: