Provider Demographics
NPI:1457136863
Name:ESSENTIAL WOMENS WELLNESS
Entity Type:Organization
Organization Name:ESSENTIAL WOMENS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:208-413-7279
Mailing Address - Street 1:3316 1/2 4TH ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4460
Mailing Address - Country:US
Mailing Address - Phone:208-413-7279
Mailing Address - Fax:
Practice Address - Street 1:3316 1/2 4TH ST STE 4B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4460
Practice Address - Country:US
Practice Address - Phone:208-413-7279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty