Healthcare Provider Details

I. General information

NPI: 1982253118
Provider Name (Legal Business Name): DESIREE IRVINE DEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 GROUSE DR
HURRICANE UT
84737-2922
US

IV. Provider business mailing address

154 GROUSE DR
HURRICANE UT
84737-2922
US

V. Phone/Fax

Practice location:
  • Phone: 435-772-5796
  • Fax: 435-215-4517
Mailing address:
  • Phone: 435-772-5796
  • Fax: 435-215-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: