Provider Demographics
NPI:1336463918
Name:ALVA ROSA, ELIZABETH (CD(DONA))
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:ALVA ROSA
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455-0548
Mailing Address - Country:US
Mailing Address - Phone:208-201-4965
Mailing Address - Fax:
Practice Address - Street 1:390 N 1ST E
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5162
Practice Address - Country:US
Practice Address - Phone:208-201-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDONA INT. CERTIFIED374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula