MEDICARE: KATHRYN GRAMLICH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	28211746A	IN
2	363LW0102X	Women's Health Nurse Practitioner	71004782A	IN
3	363LF0000X	Family Nurse Practitioner	71004782	IN

General Provider Information

NPI Number	:	1710309588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN GRAMLICH NP

Provider Business Mailing Address
First Line	:	3211 W REDDY WAY
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-4066
Country	:	US
Telephone Number	:	812-825-0777
Fax Number	:	812-331-3311

Provider Business Practice Location Address
First Line	:	3211 W REDDY WAY
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-4066
Country	:	US
Telephone Number	:	812-825-0777
Fax Number	:	812-331-3311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	06/16/2025

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