Healthcare Provider Details

I. General information

NPI: 1033211776
Provider Name (Legal Business Name): IDA RIPLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 S COTTONWOOD ST STE 130
MURRAY UT
84157
US

IV. Provider business mailing address

5161 S COTTONWOOD ST STE 130
MURRAY UT
84157
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-7070
  • Fax: 801-507-7089
Mailing address:
  • Phone: 801-507-7070
  • Fax: 801-507-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2121704402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: