Provider Demographics
NPI:1750080800
Name:GRAMLICH, KELLI N (PMHNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:N
Last Name:GRAMLICH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 PRINCETON ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2463
Mailing Address - Country:US
Mailing Address - Phone:913-314-3444
Mailing Address - Fax:
Practice Address - Street 1:1338 PRINCETON ST APT A
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2463
Practice Address - Country:US
Practice Address - Phone:913-314-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028132363LP0808X
CA95043000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse