Individual
REBEKAH FANCIULLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM,CPM
Contact information
Practice address
1076 W HAYDEN AVE, HAYDEN, ID 83835-8793
(208) 772-2823
(208) 625-2027
Mailing address
1076 W HAYDEN AVE, HAYDEN, ID 83835-8793
(208) 772-2823
(208) 625-2027
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MID-157
ID
Other
Enumeration date
04/28/2026
Last updated
04/28/2026
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