Provider Demographics
NPI:1548741820
Name:SANDPOINT HEALTH CARE, PLLC
Entity type:Organization
Organization Name:SANDPOINT HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN NP-C
Authorized Official - Phone:208-946-1730
Mailing Address - Street 1:614 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2325
Mailing Address - Country:US
Mailing Address - Phone:208-946-1730
Mailing Address - Fax:
Practice Address - Street 1:1215 MICHIGAN ST STE B
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5014
Practice Address - Country:US
Practice Address - Phone:208-946-1730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1113A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care