Provider Demographics
NPI:1235497017
Name:GALBRAITH, MARIANNE GRAF (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:GRAF
Last Name:GALBRAITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7579
Mailing Address - Country:US
Mailing Address - Phone:208-528-3060
Mailing Address - Fax:208-523-0028
Practice Address - Street 1:3430 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7579
Practice Address - Country:US
Practice Address - Phone:208-528-3060
Practice Address - Fax:208-523-0028
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7204080-4901133V00000X
IDPA-1424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered