Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MID-18 | ID |
NPI | 1134406143 |
---|---|
Provider Name | Brittany Hiller |
First Address | Meridian, ID 83646-4310 |
Second Address | Meridian, ID 83646-4310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2011 |
Last Update Date | 05/11/2011 |