Individual
JESSICA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
3679 S SHORTLEAF AVE, BOISE, ID 83716-8617
(208) 391-3995
Mailing address
3679 S SHORTLEAF AVE, BOISE, ID 83716-8617
(208) 391-3995
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
53218
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699163170
—
ID
Enumeration date
01/06/2015
Last updated
08/26/2019
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