Healthcare Provider Details

I. General information

NPI: 1548553555
Provider Name (Legal Business Name): ERIN ALEXIS SHAW MCCARTER BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W WASHINGTON ST
BOISE ID
83702-5989
US

IV. Provider business mailing address

2626 N EL RANCHO DR
BOISE ID
83704-6205
US

V. Phone/Fax

Practice location:
  • Phone: 208-484-1899
  • Fax:
Mailing address:
  • Phone: 208-484-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number107-25803
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: