Provider Demographics
NPI:1467556688
Name:GRAF, JANET G (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:G
Last Name:GRAF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N ALLUMBAUGH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9219
Mailing Address - Country:US
Mailing Address - Phone:208-323-1125
Mailing Address - Fax:208-323-9604
Practice Address - Street 1:413 N ALLUMBAUGH
Practice Address - Street 2:SUITE 103
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-658-0800
Practice Address - Fax:208-323-1894
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN21412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010148209OtherBLUE SHIELD
NPJM1OtherBLUE CROSS
000010148209OtherBLUE SHIELD
ID1342110Medicare ID - Type Unspecified
ID1342119Medicare PIN