Healthcare Provider Details

I. General information

NPI: 1780847160
Provider Name (Legal Business Name): MICHELLA ANN HABECK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 POLK ST STE F
TWIN FALLS ID
83301-4864
US

IV. Provider business mailing address

475 POLK ST STE F
TWIN FALLS ID
83301-4864
US

V. Phone/Fax

Practice location:
  • Phone: 208-751-9097
  • Fax: 208-736-0890
Mailing address:
  • Phone: 208-751-9097
  • Fax: 208-736-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM1A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: