KELLIE ANN NORTHAM

EAGLE, ID
NPI1053650010
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy367A00000X Advanced Practice Midwife
(Licence: ID  CNM81-A)
Additional Taxonomies363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: ID  CNP)
Enumeration Date2013-02-11
Last Update Date2019-05-20
Business Address
KELLIE ANN NORTHAM CNM
192 WEST STATE STREET
EAGLE, ID 83616
Phone number: 208-807-2867
Mailing Address
KELLIE ANN NORTHAM CNM
919 13TH AVE S
NAMPA, ID 83651-4618
Phone number: 712-828-0234