Healthcare Provider Details

I. General information

NPI: 1760394258
Provider Name (Legal Business Name): EVIE GOETTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVIE BELNAP

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 WYMOUNT TER
PROVO UT
84604-2041
US

IV. Provider business mailing address

683 WYMOUNT TER
PROVO UT
84604-2041
US

V. Phone/Fax

Practice location:
  • Phone: 971-708-8570
  • Fax:
Mailing address:
  • Phone: 971-708-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: