Healthcare Provider Details

I. General information

NPI: 1295166809
Provider Name (Legal Business Name): MARNAE HARWARD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
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 TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number199951-4402
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number199951-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: