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General NPI Number Information
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NPI Number | 1346752813
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Entity Type | Individual
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Provider Name | GRACE TRAAL DILLMAN CNA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 1900 NORTHWEST BLVD STE 210
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2788
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Country | US
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Telephone | 208-665-5579
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 E GARLAND AVE
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City | SPOKANE
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State | WA
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Zip | 99207-3038
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Country | US
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Telephone |
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Fax |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | ID000024275E
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License Number State | ID
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