Healthcare Provider Details

I. General information

NPI: 1609419043
Provider Name (Legal Business Name): BECKY LYNN LINDSTROM CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BECKY LYNN WARE

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 11/27/2023
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E 90 N STE 300
AMERICAN FORK UT
84003-2956
US

IV. Provider business mailing address

585 N 500 W ATTN: CREDENTIALING
PROVO UT
84601-1548
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-1577
  • Fax:
Mailing address:
  • Phone: 801-374-1801
  • Fax: 801-216-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number2162324402
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2162324402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: