Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MID-99 | ID |
NPI | 1134761216 |
---|---|
Provider Name | Samantha J Nuxoll |
First Address | Meridian, ID 83642-2437 |
Second Address | Meridian, ID 83642-2437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2019 |
Last Update Date | 10/10/2019 |