Individual
MS. SHAUNDRA RENEE FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APRN, CNM
Contact information
Practice address
207 W WASHINGTON ST, BOISE, ID 83702-5989
(208) 343-2079
(208) 343-6828
Mailing address
207 W WASHINGTON ST, BOISE, ID 83702-5989
(208) 343-2079
(208) 343-6828
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
A-80
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CNM-80A
ADVANCED PRACTICE LICENSE
ID
Enumeration date
12/15/2014
Last updated
03/30/2015
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