Provider Demographics
NPI:1003433350
Name:LANHAM, ASHLEY ROCHELLE (CNM)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROCHELLE
Last Name:LANHAM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:737-256-2763
Mailing Address - Fax:
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:208-343-6868
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID68123367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife