Provider Demographics
NPI:1932677515
Name:GRAMES, ELIZABETH KIDDER (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KIDDER
Last Name:GRAMES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 NAVARRE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3224
Mailing Address - Country:US
Mailing Address - Phone:419-698-8560
Mailing Address - Fax:419-698-8570
Practice Address - Street 1:2702 NAVARRE AVE STE 201
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3224
Practice Address - Country:US
Practice Address - Phone:419-698-8560
Practice Address - Fax:419-698-8570
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1225015605207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology