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General NPI Number Information
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NPI Number | 1205328333
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Entity Type | Individual
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Provider Name | KRYSTA MARIA FREED LM, CPM
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Gender | Female
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 6456 W KAMLOOPS DR
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City | RATHDRUM
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State | ID
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Zip | 83858-6417
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Country | US
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Telephone | 208-699-3625
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Fax |
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Provider Business Mailing Address
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Address Line | 686 S WIDGEON ST
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City | POST FALLS
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State | ID
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Zip | 83854-6212
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Country | US
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Telephone | 208-964-1394
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Fax | 208-567-1640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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