Individual
ELLY MARIE WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
1072 N LIBERTY ST STE 100, BOISE, ID 83704-8708
(208) 302-1200
(208) 302-1255
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
163WX0003X
Inpatient Obstetric Registered Nurse
46698
ID
367A00000X
Advanced Practice Midwife
Primary
5771963
ID
Other
Enumeration date
06/05/2025
Last updated
07/28/2025
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