Healthcare Provider Details

I. General information

NPI: 1124080775
Provider Name (Legal Business Name): MELISSA A BOLL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA A BORRACK CNM

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 03/20/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 S UNION PARK CTR STE 600
COTTONWOOD HEIGHTS UT
84047-4187
US

IV. Provider business mailing address

6975 S UNION PARK CTR
COTTONWOOD HEIGHTS UT
84047-6048
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax: 888-732-8119
Mailing address:
  • Phone: 888-731-8994
  • Fax: 833-775-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number5713781-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: