Provider Demographics
NPI:1548742679
Name:HAZELTREE MIDWIFERY PLLC
Entity Type:Organization
Organization Name:HAZELTREE MIDWIFERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:LM CPM
Authorized Official - Phone:208-699-3625
Mailing Address - Street 1:6456 W KAMLOOPS DR
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-6417
Mailing Address - Country:US
Mailing Address - Phone:208-777-5800
Mailing Address - Fax:
Practice Address - Street 1:1048 N 3RD ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3110
Practice Address - Country:US
Practice Address - Phone:208-777-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty