Healthcare Provider Details

I. General information

NPI: 1538231808
Provider Name (Legal Business Name): DEBORAH RUTH FLANSBURG CNM, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N 400 E STE A
NORTH LOGAN UT
84341-1756
US

IV. Provider business mailing address

PO BOX 743120
ATLANTA GA
30374-3120
US

V. Phone/Fax

Practice location:
  • Phone: 435-713-1300
  • Fax: 435-713-1320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number197676-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: