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General NPI Number Information
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NPI Number | 1255636304
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Entity Type | Individual
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Provider Name | KATHY LEBARON L.M., C.P.M
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Gender | Female
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 297N 3855 EAST
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City | RIGBY
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State | ID
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Zip | 83442
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Country | US
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Telephone | 208-745-7571
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Fax | 208-745-8924
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Provider Business Mailing Address
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Address Line | 334 RANDY DR
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City | REXBURG
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State | ID
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Zip | 83440-1712
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Country | US
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Telephone | 208-351-1823
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Fax | 208-745-8924
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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 | MID - 19
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License Number State | ID
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