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General NPI Number Information
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NPI Number | 1437028834
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Entity Type | Individual
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Provider Name | KRYSTLE BETH GROTHJAN NP
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Gender | Female
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 211 W FOREST STREET
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City | MCCALL
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State | ID
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Zip | 83638-9998
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Country | US
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Telephone | 208-630-2219
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1983
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City | MCCALL
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State | ID
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Zip | 83638-9998
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Country | US
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Telephone | 208-792-7274
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 57716
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License Number State | ID
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