Healthcare Provider Details

I. General information

NPI: 1881436988
Provider Name (Legal Business Name): CRISTINA MARIE MCLENNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 S 1000 E
SALT LAKE CITY UT
84102-3618
US

IV. Provider business mailing address

732 S 1000 E
SALT LAKE CITY UT
84102-3618
US

V. Phone/Fax

Practice location:
  • Phone: 760-415-3062
  • Fax:
Mailing address:
  • Phone: 760-415-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: