Provider Demographics
NPI:1144095183
Name:DATER-TWOMEY, JULIE (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DATER-TWOMEY
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15005 N MCFARLAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9513
Mailing Address - Country:US
Mailing Address - Phone:208-484-2276
Mailing Address - Fax:
Practice Address - Street 1:207 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5941
Practice Address - Country:US
Practice Address - Phone:208-343-2079
Practice Address - Fax:208-343-6828
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID77575363LW0102X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health