Healthcare Provider Details

I. General information

NPI: 1457109027
Provider Name (Legal Business Name): MAAIAN GEFEN RN, DEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 E 12300 S
DRAPER UT
84020-8276
US

IV. Provider business mailing address

3608 EASTWOOD DR
SALT LAKE CITY UT
84109-3809
US

V. Phone/Fax

Practice location:
  • Phone: 801-252-6243
  • Fax:
Mailing address:
  • Phone: 801-884-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: