Individual
HANNA ROSE BLACKMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM, CPM
Contact information
Practice address
1593 N 5600 W, MALAD CITY, ID 83252-4502
(801) 916-5288
Mailing address
1593 N 5600 W, MALAD CITY, ID 83252-4502
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MID-161
ID
Other
Enumeration date
08/13/2024
Last updated
08/13/2024
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