Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MID-38 | ID |
NPI | 1114297934 |
---|---|
Provider Name | Valerie Jean Hall |
First Address | Rigby, ID 83442-5124 |
Second Address | Rigby, ID 83442-5124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2012 |
Last Update Date | 10/01/2012 |