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General NPI Number Information
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NPI Number | 1124483821
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE MIDWIFERY AND BIRTH CENTER
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 520 16TH AVE N
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City | NAMPA
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State | ID
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Zip | 83687-3538
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Country | US
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Telephone | 208-467-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 520 16TH AVE N
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City | NAMPA
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State | ID
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Zip | 83687-3538
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Country | US
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Telephone | 208-467-1230
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. ANNETTE MARIE LEWIS
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Credential | CPM, LM
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Telephone | 208-467-1230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MID-23
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License Number State | ID
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