Provider Demographics
NPI:1659535334
Name:PENWELL, ROSEMARY E (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:E
Last Name:PENWELL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 W PATTIE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-1245
Mailing Address - Country:US
Mailing Address - Phone:208-570-4578
Mailing Address - Fax:
Practice Address - Street 1:3018 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3059
Practice Address - Country:US
Practice Address - Phone:208-570-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-3176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife