Jill Reena Gustafson, CNM
Advanced Practice Midwife in Boise, ID. Individual provider (NPI-1).
NPI number1992224166
StatusActive
Last updated in NPPESMar 9, 2022
Details
- NPI
- 1992224166
- Entity type
- Individual (NPI-1)
- Name
- Jill Reena Gustafson
- Credential
- CNM
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 19, 2017
- Certification date
- Mar 9, 2022
- Last updated
- Mar 9, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367A00000X | Advanced Practice Midwife | 56670 | ID | Yes |
| 163W00000X | Registered Nurse | 56670 | ID |
Practice location
4948 W Kootenai St Ste 100Boise, ID 83705-2002
Phone 208-510-0261 · Fax 208-225-4243
Mailing address
4948 W Kootenai St Ste 100Boise, ID 83705-2002
Phone 208-510-0261 · Fax 208-225-4243
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All 29 Advanced Practice Midwife providers in Boise · All 12,265 providers in Boise
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