Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | ID-130 | ID |
NPI | 1124771613 |
---|---|
Provider Name | Mrs. Sarah Pagano |
First Address | Nampa, ID 83651-1439 |
Second Address | Meridian, ID 83642-2437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2022 |
Last Update Date | 03/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CPM22010005 | NARM (01) |