Provider Demographics
NPI:1790590438
Name:TAYLOR, LAURA BALBEN (CNM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BALBEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARSHALL
Other - Last Name:BALBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2512 N REDWAY RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-6053
Mailing Address - Country:US
Mailing Address - Phone:208-709-6909
Mailing Address - Fax:
Practice Address - Street 1:333 N 1ST ST STE 240
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6132
Practice Address - Country:US
Practice Address - Phone:208-338-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9871046367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty