Provider Demographics
NPI:1003243890
Name:BOISE WOMEN'S HEALTH & BIRTH CENTER
Entity Type:Organization
Organization Name:BOISE WOMEN'S HEALTH & BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:208-724-6933
Mailing Address - Street 1:2296 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0833
Mailing Address - Country:US
Mailing Address - Phone:208-724-6933
Mailing Address - Fax:
Practice Address - Street 1:1502 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4028
Practice Address - Country:US
Practice Address - Phone:208-724-6933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QB0400X
IDCNM52A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing