Provider Demographics
NPI:1508160094
Name:WARD, CATHY MARIE (LM)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:MARIE
Last Name:WARD
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PINEHOLLOW
Mailing Address - Street 2:
Mailing Address - City:KOOSKIA
Mailing Address - State:ID
Mailing Address - Zip Code:83539-5157
Mailing Address - Country:US
Mailing Address - Phone:208-926-7221
Mailing Address - Fax:
Practice Address - Street 1:102 PINEHOLLOW
Practice Address - Street 2:
Practice Address - City:KOOSKIA
Practice Address - State:ID
Practice Address - Zip Code:83539-5157
Practice Address - Country:US
Practice Address - Phone:208-926-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMIDGM-26176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife