Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MID-93 | ID |
NPI | 1164983417 |
---|---|
Provider Name | Victoria Engelhard |
First Address | Boise, ID 83705-3059 |
Second Address | Boise, ID 83705-3059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2019 |
Last Update Date | 28/03/2019 |