1114017902 NPI number — MRS. CLAUDETTE COUGHENOUR MCDANIEL LM CPM

Table of content: CAITLIN VLAEMINCK (NPI 1083919161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114017902 NPI number — MRS. CLAUDETTE COUGHENOUR MCDANIEL LM CPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDANIEL
Provider First Name:
CLAUDETTE
Provider Middle Name:
COUGHENOUR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LM CPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COUGHENOUR
Provider Other First Name:
CLAUDETTE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114017902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 CALDWELL BLVD
Provider Second Line Business Mailing Address:
#1016
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-738-6786
Provider Business Mailing Address Fax Number:
707-674-5512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
972 S MOORSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83634-2586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-738-6786
Provider Business Practice Location Address Fax Number:
707-674-5512
Provider Enumeration Date:
10/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  MID-125 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 97030003 . This is a "NARM CERTIFIED PROFESSIONAL MIDWIFE CPM" identifier . This identifiers is of the category "OTHER".
  • Identifier: MID-125 . This is a "DOPL BOARD OF NURSING MIDWIFE LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 12280 . This is a "LAMAZE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".