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General NPI Number Information
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NPI Number | 1780834077
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Entity Type | Organization
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Legal Business Name | AGAPE BIRTH SERVICE AND BIRTH CENTER
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 04/10/2012
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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 | OWNER
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Name | MRS. MICHELLE RAE BARTLETT
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Credential | CPM.
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Telephone | 208-745-7571
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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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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MID-38
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP868A
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MID-9
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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