Healthcare Provider Details

I. General information

NPI: 1386118255
Provider Name (Legal Business Name): ANNETTE RANAE HIMES DNP, CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 W ANTELOPE DR BSMT
LAYTON UT
84041-1143
US

IV. Provider business mailing address

PO BOX 337
LAYTON UT
84041-0337
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-4840
  • Fax:
Mailing address:
  • Phone: 801-773-4840
  • Fax: 801-525-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number9415492-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number9415492-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: