Healthcare Provider Details

I. General information

NPI: 1710993753
Provider Name (Legal Business Name): PETER S BARNARD CNM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/26/2022
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E 3900 S STE 400
SALT LAKE CITY UT
84124-1228
US

IV. Provider business mailing address

PO BOX 198546
ATLANTA GA
30384-8546
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-6811
  • Fax: 801-268-8673
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number218615-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: