Hanna Rose Blackmore, LM, CPM
Individual provider Active NPI Midwife · Malad City, ID
NPI 1235960899 · NPPES record last updated Aug 13, 2024
Key facts
- NPI
- 1235960899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Midwife 176B00000X
- License
- MID-161 (ID)
- Practice address
- 1593 N 5600 W
Malad City, ID 83252-4502 - Phone
- (801) 916-5288
- NPI assigned
- Aug 13, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MID-161 | ID | MD | Midwife |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | MID-161 | ID | Yes |
Addresses
Primary practice location
1593 N 5600 W
Malad City, ID 83252-4502
Mailing address
1593 N 5600 W
Malad City, ID 83252-4502
Other names
- Hanna Blackmore
Other providers in Malad City, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.