Healthcare Provider Details

I. General information

NPI: 1730445974
Provider Name (Legal Business Name): RACHEL D MAST CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 W OVERLAND RD
BOISE ID
83705-3059
US

IV. Provider business mailing address

3018 W OVERLAND RD
BOISE ID
83705-3059
US

V. Phone/Fax

Practice location:
  • Phone: 208-884-1223
  • Fax:
Mailing address:
  • Phone: 208-608-5954
  • Fax: 208-509-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMID-44
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: