Provider Demographics
NPI:1588301568
Name:KISH, GLYNDA (OFFICE COORDINATOR)
Entity type:Individual
Prefix:
First Name:GLYNDA
Middle Name:
Last Name:KISH
Suffix:
Gender:F
Credentials:OFFICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E LINDEN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6177
Mailing Address - Country:US
Mailing Address - Phone:208-415-0366
Mailing Address - Fax:208-625-2000
Practice Address - Street 1:302 E LINDEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6177
Practice Address - Country:US
Practice Address - Phone:208-415-0366
Practice Address - Fax:208-625-2000
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNONEOtherHOME CARE