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General NPI Number Information
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NPI Number | 1437965019
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Entity Type | Organization
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Legal Business Name | FULL MOON MIDWIFERY
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2201 N GOVERNMENT WAY STE C
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3658
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Country | US
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Telephone | 509-867-7821
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 N 14TH ST
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4468
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Country | US
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Telephone |
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Fax | 208-601-6126
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Authorized Official
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Title or Position | OWNER
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Name | ALICIA HOXIE
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Credential | LM, CPM
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Telephone | 509-867-7821
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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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