Healthcare Provider Details

I. General information

NPI: 1679759278
Provider Name (Legal Business Name): DEANNE R WILLIAMS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD STREET
MURRAY UT
84157-7000
US

IV. Provider business mailing address

5121 S COTTONWOOD STREET
MURRAY UT
84157-7000
US

V. Phone/Fax

Practice location:
  • Phone: 801-634-2114
  • Fax:
Mailing address:
  • Phone: 801-634-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1993124402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: