Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MID-62 | ID |
NPI | 1003206194 |
---|---|
Provider Name | Mrs. Sarah Warner |
First Address | Meridian, ID 83642-2437 |
Second Address | Meridian, ID 83642-2437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2015 |
Last Update Date | 28/01/2015 |