Provider Demographics
NPI:1861777005
Name:SPURLOCK, MICHELLE MARIE (CPM, LM)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 W CHERRY LN
Mailing Address - Street 2:#405
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1119
Mailing Address - Country:US
Mailing Address - Phone:208-761-5405
Mailing Address - Fax:208-888-1146
Practice Address - Street 1:3313 W CHERRY LN
Practice Address - Street 2:#405
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1119
Practice Address - Country:US
Practice Address - Phone:208-761-5405
Practice Address - Fax:208-888-1146
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-39176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife