Healthcare Provider Details

I. General information

NPI: 1811271000
Provider Name (Legal Business Name): DIANNE GWEN BJARNSON L.D.E.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 HILLSIDE DR
PLEASANT GROVE UT
84062-2056
US

IV. Provider business mailing address

1243 HILLSIDE DR
PLEASANT GROVE UT
84062-2056
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-9272
  • Fax: 801-642-4425
Mailing address:
  • Phone: 801-785-9272
  • Fax: 801-642-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number6326927-3400
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: