Provider Demographics
NPI:1073566089
Name:AINSLIE, GEORGIANNA T (CNM)
Entity Type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:T
Last Name:AINSLIE
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 1:5966 CURTISIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8801
Mailing Address - Country:US
Mailing Address - Phone:208-375-8100
Mailing Address - Fax:208-373-2643
Practice Address - Street 1:5966 CURTISIAN AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8801
Practice Address - Country:US
Practice Address - Phone:208-375-8100
Practice Address - Fax:208-373-2643
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N28479367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010017812OtherBLUE SHIELD
IDNPKT2OtherBLUE CROSS