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General NPI Number Information
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NPI Number | 1588329718
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Entity Type | Individual
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Provider Name | TAMMY LYNN DESJARDINS LM,CPM,BSM
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Gender | Female
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 1415 E RANDLE AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4832
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Country | US
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Telephone | 509-994-8712
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Fax | 208-215-2531
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Provider Business Mailing Address
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Address Line | 1415 E RANDLE AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4832
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Country | US
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Telephone | 509-994-8712
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Fax | 208-215-2531
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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-121
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License Number State | ID
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