=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477417038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA GRINER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 W 6TH ST STE 208
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843-2387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-882-3504
-----------------------------------------------------
Fax | 877-935-2107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 W 6TH ST STE 208
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843-2387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-882-3504
-----------------------------------------------------
Fax | 877-935-2107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------