Healthcare Provider Details

I. General information

NPI: 1023410347
Provider Name (Legal Business Name): LAURA JEAN HOPPER CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2862 E OVERLOOK DR
ST GEORGE UT
84790-6417
US

IV. Provider business mailing address

1707 SCOTT DR
LOUISVILLE TN
37777-5005
US

V. Phone/Fax

Practice location:
  • Phone: 435-669-5610
  • Fax:
Mailing address:
  • Phone: 435-669-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number12304860-3400
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number330193
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: