Individual
MS. SUSIE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPM, LM
Contact information
Practice address
9540 W DORSETSHIRE PL, BOISE, ID 83704-2229
(208) 284-0200
Mailing address
9540 W DORSETSHIRE PL, BOISE, ID 83704-2229
(208) 284-0200
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MID-54
ID
Other
Enumeration date
04/21/2014
Last updated
04/21/2014
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