Healthcare Provider Details

I. General information

NPI: 1790823375
Provider Name (Legal Business Name): TREASURE VALLEY MIDWIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W WASHINGTON ST
BOISE ID
83702-5989
US

IV. Provider business mailing address

207 W WASHINGTON ST
BOISE ID
83702-5989
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-2079
  • Fax: 208-343-6828
Mailing address:
  • Phone: 208-343-2079
  • Fax: 208-343-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON R KELLEY
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 208-343-2079