Healthcare Provider Details

I. General information

NPI: 1912231473
Provider Name (Legal Business Name): MARIE A BIGELOW MT-BC, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 S CRIMSON ROSE AVE
BOISE ID
83709-8229
US

IV. Provider business mailing address

1828 S CRIMSON ROSE AVE
BOISE ID
83709-8229
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-3917
  • Fax:
Mailing address:
  • Phone: 208-376-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: