Provider Demographics
NPI:1013412402
Name:KITTERMAN, MEGAN ASHLEY (CNM)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ASHLEY
Last Name:KITTERMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N 1ST ST STE 260
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6132
Mailing Address - Country:US
Mailing Address - Phone:208-345-3136
Mailing Address - Fax:208-345-0984
Practice Address - Street 1:333 N 1ST ST STE 260
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6132
Practice Address - Country:US
Practice Address - Phone:208-345-3136
Practice Address - Fax:208-345-0984
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58221367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife