Provider Demographics
NPI:1780847160
Name:HABECK, MICHELLA ANN (CNM)
Entity Type:Individual
Prefix:
First Name:MICHELLA
Middle Name:ANN
Last Name:HABECK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:475 POLK ST STE F
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4864
Mailing Address - Country:US
Mailing Address - Phone:208-751-9097
Mailing Address - Fax:208-736-0890
Practice Address - Street 1:475 POLK ST STE F
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4864
Practice Address - Country:US
Practice Address - Phone:208-751-9097
Practice Address - Fax:208-736-0890
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDCNM1A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife