Provider Demographics
NPI:1669779229
Name:DIFELICE COOK, JANICE MARIE (LM)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:MARIE
Last Name:DIFELICE COOK
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 SMITH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE
Mailing Address - State:ID
Mailing Address - Zip Code:83647-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:176 SMITH CREEK RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE
Practice Address - State:ID
Practice Address - Zip Code:83647-8442
Practice Address - Country:US
Practice Address - Phone:208-631-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMIDGM30176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife