Healthcare Provider Details

I. General information

NPI: 1710561162
Provider Name (Legal Business Name): BONNIE ALAINE WALSER RIVAS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W ST LUKES DR STE 229
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: 208-706-3220
  • Fax: 208-706-3221
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number68107
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number68107
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: