Provider Demographics
NPI:1568105518
Name:MEYER, STEPHANIE (CPM, LM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 N 3855 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5124
Mailing Address - Country:US
Mailing Address - Phone:208-220-2941
Mailing Address - Fax:
Practice Address - Street 1:297 N 3855 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5124
Practice Address - Country:US
Practice Address - Phone:208-220-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-129176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife