Healthcare Provider Details

I. General information

NPI: 1568216042
Provider Name (Legal Business Name): ISABELLE LISA MONTGOMERY CPM, LDEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 S 900 E STE 201
MURRAY UT
84117-5724
US

IV. Provider business mailing address

566 W 2100 N
LEHI UT
84043-9726
US

V. Phone/Fax

Practice location:
  • Phone: 801-820-4459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number14277260-3400
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: