Active NPI
Machelle F. Peterson, CNM
- Advanced Practice Midwife
- Tensed, ID
National Provider Identifier
1689216095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- 62928
- Practice address
- 468 Lonesome Dove LN
Tensed, ID 83870-8387 - Phone
- (208) 874-3095
- NPI assigned
- Oct 17, 2019
- Last updated
- Nov 6, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 61016081 | WA | |
| Advanced Practice Midwife | 367A00000X | 62928 | ID | Primary |
Addresses
Primary practice location
468 Lonesome Dove LN
Tensed, ID 83870-8387
Mailing address
PO Box 93
Tensed, ID 83870-0093
Phone (208) 874-3095
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62928 | Other | ID | CNM PROVIDER LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62928 | ID | MD | Advanced Practice Midwife |
| 61016081 | WA | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699228800000",
"number": "1689216095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 93",
"city": "TENSED",
"state": "ID",
"postal_code": "838700093",
"telephone_number": "208-874-3095",
"fax_number": "833-900-1404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "468 LONESOME DOVE LN",
"city": "TENSED",
"state": "ID",
"postal_code": "838708387",
"telephone_number": "208-874-3095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MACHELLE",
"middle_name": "F.",
"credential": "CNM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-17",
"last_updated": "2023-11-06",
"certification_date": "2023-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "WA",
"license": "61016081",
"primary": false
},
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "ID",
"license": "62928",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CNM PROVIDER LICENSE",
"identifier": "62928",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tensed, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.