Healthcare Provider Details

I. General information

NPI: 1336669100
Provider Name (Legal Business Name): VITALITY GENERATION & MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 S 500 E STE C
OGDEN UT
84405-7218
US

IV. Provider business mailing address

431 E 2700 N
OGDEN UT
84414-2332
US

V. Phone/Fax

Practice location:
  • Phone: 801-917-6104
  • Fax: 801-436-5182
Mailing address:
  • Phone: 801-628-4573
  • Fax: 801-436-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORETTA S. SHUPE
Title or Position: CEO
Credential: CPM
Phone: 801-628-4573