Provider Demographics
NPI:1487140265
Name:MATUSHKA OLGA MICHAEL MATERNITY ASSOCIATES, INC
Entity type:Organization
Organization Name:MATUSHKA OLGA MICHAEL MATERNITY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:712-828-0234
Mailing Address - Street 1:919 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4618
Mailing Address - Country:US
Mailing Address - Phone:712-828-0234
Mailing Address - Fax:208-965-8789
Practice Address - Street 1:116 18TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4841
Practice Address - Country:US
Practice Address - Phone:208-639-2700
Practice Address - Fax:208-639-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNM81-A176B00000X
363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty