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General NPI Number Information
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NPI Number | 1790823375
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Entity Type | Organization
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Legal Business Name | TREASURE VALLEY MIDWIVES, LLC
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 207 W WASHINGTON ST
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City | BOISE
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State | ID
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Zip | 83702-5989
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Country | US
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Telephone | 208-343-2079
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Fax | 208-343-6828
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Provider Business Mailing Address
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Address Line | 207 W WASHINGTON ST
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City | BOISE
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State | ID
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Zip | 83702-5989
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Country | US
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Telephone | 208-343-2079
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Fax | 208-343-6828
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | SHANNON R KELLEY
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Credential |
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Telephone | 208-343-2079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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Taxonomy #4
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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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