Healthcare Provider Details

I. General information

NPI: 1538085899
Provider Name (Legal Business Name): REBEKAH ALEXANDER CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 BRUSH CREEK RD
DEARY ID
83823-9763
US

IV. Provider business mailing address

1144 BRUSH CREEK RD
DEARY ID
83823-9763
US

V. Phone/Fax

Practice location:
  • Phone: 208-877-1032
  • Fax:
Mailing address:
  • Phone: 208-877-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number4881516
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: