Healthcare Provider Details

I. General information

NPI: 1982426839
Provider Name (Legal Business Name): JULIA ANN LOCKHART CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W ST LUKES DR
NAMPA ID
83687-7912
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 808-212-6651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number58833
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number3371243
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3371243
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: