Healthcare Provider Details

I. General information

NPI: 1114333598
Provider Name (Legal Business Name): ROXANNA MAURER CPM, LDEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S 500 W
PAYSON UT
84651-2713
US

IV. Provider business mailing address

575 S 500 W
PAYSON UT
84651-2713
US

V. Phone/Fax

Practice location:
  • Phone: 801-787-1400
  • Fax: 801-405-0345
Mailing address:
  • Phone: 801-787-1400
  • Fax: 801-405-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number10829412-3400
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: