Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MID-98 | ID |
NPI | 1114572476 |
---|---|
Provider Name | Rachel Dolph |
First Address | Sandpoint, ID 83864-1486 |
Second Address | Sandpoint, ID 83864-1486 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2019 |
Last Update Date | 05/08/2019 |