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General NPI Number Information
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NPI Number | 1649900580
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Entity Type | Organization
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Legal Business Name | BOISE BIRTH VILLAGE
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 726 W BURY ST
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City | KUNA
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State | ID
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Zip | 83634-2374
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Country | US
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Telephone | 208-991-0097
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Fax |
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Provider Business Mailing Address
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Address Line | 784 S CLEARWATER LOOP STE D
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City | POST FALLS
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State | ID
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Zip | 83854-9599
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Country | US
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Telephone | 208-991-0097
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHARINA E JENSEN
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Credential | BA, CD(DONA), CLC
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Telephone | 208-991-0097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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