MEDICARE: DEZARAE WEYBURN LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1114781531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEZARAE WEYBURN LMT

Provider Business Mailing Address
First Line	:	2916 W 1600 N
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-7906
Country	:	US
Telephone Number	:	801-389-4633
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 W 1600 N
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-7906
Country	:	US
Telephone Number	:	801-389-4633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	02/07/2024

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