Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MID-66 | ID |
NPI | 1053785519 |
---|---|
Provider Name | Mrs. Danielle Megann Boettcher White |
First Address | Victor, ID 83455-0995 |
Second Address | Rigby, ID 83442-5124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2015 |
Last Update Date | 20/11/2015 |