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General NPI Number Information
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NPI Number | 1497037758
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Entity Type | Individual
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Provider Name | PATTY J ACKERMAN DNP, CNM, APRN
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Gender | Female
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 804 S MAIN ST
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City | GRACE
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State | ID
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Zip | 83241-4712
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Country | US
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Telephone | 208-220-7111
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Fax | 208-269-1491
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Provider Business Mailing Address
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Address Line | 804 S MAIN ST
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City | GRACE
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State | ID
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Zip | 83241-4712
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Country | US
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Telephone | 208-220-7111
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Fax | 208-269-1491
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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 | CMN61A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CMN61A
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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