Provider Demographics
NPI:1306737580
Name:EVOLVE OBGYN, PLLC
Entity type:Organization
Organization Name:EVOLVE OBGYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-991-8132
Mailing Address - Street 1:4600 N GINZEL ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-4264
Mailing Address - Country:US
Mailing Address - Phone:208-991-8132
Mailing Address - Fax:
Practice Address - Street 1:300 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6207
Practice Address - Country:US
Practice Address - Phone:208-991-8132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty