Healthcare Provider Details

I. General information

NPI: 1164931390
Provider Name (Legal Business Name): ANNALISA BALL BURCH RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 W 180 S
SPANISH FORK UT
84660-4628
US

IV. Provider business mailing address

764 W 180 S
SPANISH FORK UT
84660-4628
US

V. Phone/Fax

Practice location:
  • Phone: 801-368-1914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number14291213-4402
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number7976366-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: