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General NPI Number Information
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NPI Number | 1770657512
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Entity Type | Individual
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Provider Name | CONNIE J WOLCOTT CNM
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 297 N. 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 | 297 N. 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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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | CNM-24A
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License Number State | ID
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