Healthcare Provider Details

I. General information

NPI: 1770615684
Provider Name (Legal Business Name): MARCIA A. SCOVILLE C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 E 3300 S
SALT LAKE CITY UT
84109-2728
US

IV. Provider business mailing address

2605 E 3300 S
SALT LAKE CITY UT
84109-2728
US

V. Phone/Fax

Practice location:
  • Phone: 801-746-7467
  • Fax: 801-746-7469
Mailing address:
  • Phone: 801-746-7467
  • Fax: 801-746-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number214228-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: