Provider Demographics
NPI:1790823375
Name:TREASURE VALLEY MIDWIVES, LLC
Entity Type:Organization
Organization Name:TREASURE VALLEY MIDWIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE-MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, LM
Authorized Official - Phone:208-343-2079
Mailing Address - Street 1:207 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5989
Mailing Address - Country:US
Mailing Address - Phone:208-343-2079
Mailing Address - Fax:208-343-6828
Practice Address - Street 1:207 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5989
Practice Address - Country:US
Practice Address - Phone:208-343-2079
Practice Address - Fax:208-343-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID107-25803163WL0100X
IDMID-18176B00000X
IDMID-40176B00000X
IDMID-46176B00000X
IDMID-56176B00000X
IDCNM 60A367A00000X
IDCNM 51A367A00000X
IDCNM-70A367A00000X
IDCNM-69A367A00000X
IDCNM-76A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty