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General NPI Number Information
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NPI Number | 1235497017
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Entity Type | Individual
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Provider Name | MARIANNE GRAF GALBRAITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 3430 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7579
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Country | US
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Telephone | 208-528-3060
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Fax | 208-523-0028
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Provider Business Mailing Address
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Address Line | 3430 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7579
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Country | US
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Telephone | 208-528-3060
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Fax | 208-523-0028
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1424
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 7204080-4901
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License Number State | UT
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