Healthcare Provider Details

I. General information

NPI: 1093312183
Provider Name (Legal Business Name): CHERYSH HUBBARD STOCK DNP, WHNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYSH FELICIA HUBBARD DNP, WHNP, CNM

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

1599 W ELSIE DR
TAYLORSVILLE UT
84123-5208
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-1800
  • Fax:
Mailing address:
  • Phone: 208-221-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number9492401-4402
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number9492401-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: