Individual
JILL REENA GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
4948 W KOOTENAI ST STE 100, BOISE, ID 83705-2002
(208) 510-0261
(208) 225-4243
Mailing address
4948 W KOOTENAI ST STE 100, BOISE, ID 83705-2002
(208) 510-0261
(208) 225-4243
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
56670
ID
367A00000X
Advanced Practice Midwife
Primary
56670
ID
Other
Enumeration date
09/19/2017
Last updated
03/09/2022
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