Healthcare Provider Details

I. General information

NPI: 1073170049
Provider Name (Legal Business Name): BREATH2LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8884 W CYPRUS ST
COPPERTON UT
84006-5511
US

IV. Provider business mailing address

8884 W CYPRUS ST
COPPERTON UT
84006-5511
US

V. Phone/Fax

Practice location:
  • Phone: 801-500-3398
  • Fax:
Mailing address:
  • Phone: 801-500-3398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. CHELSEA DIANA UDELL
Title or Position: OWNER
Credential:
Phone: 801-500-3398