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NPI Code Detail

MEDICARE: CHELYN CRAPO FULLMER

MEDICARE: CHELYN CRAPO FULLMER
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
1367A00000XAdvanced Practice Midwife8005666-4402UT

General Provider Information

NPI Number : 1740656453
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHELYN CRAPO FULLMER
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5373 W LAKE PARK BLVD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84120-8208
Country : US
Telephone Number : 801-902-7960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2015
Last Update Date : 03/20/2019

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Directions to “ CHELYN CRAPO FULLMER ” Practice Location

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