Healthcare Provider Details

I. General information

NPI: 1679643498
Provider Name (Legal Business Name): WOMEN & BIRTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 E 4500 S STE 150
HOLLADAY UT
84117
US

IV. Provider business mailing address

2180 E 4500 S STE 150
HOLLADAY UT
84117
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-3102
  • Fax: 801-278-3660
Mailing address:
  • Phone: 801-278-3102
  • Fax: 801-278-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number47473784402
License Number StateUT

VIII. Authorized Official

Name: REBECCA ANN MCINNIS
Title or Position: PRESIDENT
Credential: CNM
Phone: 801-278-3102