Provider Demographics
NPI:1912899840
Name:GARDOM, SHEILA MARIE (CPM, LM)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:GARDOM
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 1:4407 OREGON AVE.
Mailing Address - Street 2:CALDWELL, ID. 83607
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607
Mailing Address - Country:US
Mailing Address - Phone:208-409-9064
Mailing Address - Fax:
Practice Address - Street 1:270 N LINDER RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2437
Practice Address - Country:US
Practice Address - Phone:208-884-1223
Practice Address - Fax:208-887-1935
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7571668176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife