Healthcare Provider Details

I. General information

NPI: 1245324086
Provider Name (Legal Business Name): BREASTFEEDING ESSENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 UNION SQ
SANDY UT
84070-3403
US

IV. Provider business mailing address

676 UNION SQ
SANDY UT
84070-3403
US

V. Phone/Fax

Practice location:
  • Phone: 801-568-7020
  • Fax: 801-569-2603
Mailing address:
  • Phone: 801-568-7020
  • Fax: 801-569-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number69610
License Number StateUT

VIII. Authorized Official

Name: MRS. HEIDEMARIE HALL
Title or Position: OWNER MANAGER FITTER
Credential: R.N., C.M.F
Phone: 801-568-7020