Provider Demographics
NPI:1669960506
Name:NEWMAN, TABITHA S (LM, CPM)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:S
Last Name:NEWMAN
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 1:9732 N 70TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5566
Mailing Address - Country:US
Mailing Address - Phone:208-360-1703
Mailing Address - Fax:
Practice Address - Street 1:9732 N 70TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5566
Practice Address - Country:US
Practice Address - Phone:208-360-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-82176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty