Provider Demographics
NPI:1417910506
Name:MUNTING, BABETTE NOELLE (NP)
Entity Type:Individual
Prefix:
First Name:BABETTE
Middle Name:NOELLE
Last Name:MUNTING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BABETTE
Other - Middle Name:NOELLE
Other - Last Name:GEURTSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1508 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1508 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-3505
Practice Address - Country:US
Practice Address - Phone:208-631-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP584A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8065779Medicaid
ID1417910506Medicaid
ID8065779Medicaid