Individual
METTA KATHERINE LEE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNM
Contact information
Practice address
412 E 41ST ST STE 2, BOISE, ID 83714-6348
(208) 742-4784
Mailing address
412 E 41ST ST STE 2, BOISE, ID 83714-6348
(208) 742-4784
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
10009959
OR
163W00000X
Registered Nurse
54221
ID
367A00000X
Advanced Practice Midwife
13419449-4402
UT
367A00000X
Advanced Practice Midwife
2023027340
MO
367A00000X
Advanced Practice Midwife
Primary
54221
ID
367A00000X
Advanced Practice Midwife
852
NM
Other
Enumeration date
10/18/2016
Last updated
08/25/2023
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