Provider Demographics
NPI:1003323858
Name:TOBECK, SOPHIE (CNM)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:TOBECK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:E
Other - Last Name:NESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:207 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5941
Mailing Address - Country:US
Mailing Address - Phone:208-343-2079
Mailing Address - Fax:208-343-6828
Practice Address - Street 1:207 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5941
Practice Address - Country:US
Practice Address - Phone:208-343-2079
Practice Address - Fax:208-343-6828
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57704367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife