Healthcare Provider Details

I. General information

NPI: 1386036440
Provider Name (Legal Business Name): JANAE SHERMAN LDEM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W 250 N
ST GEORGE UT
84770-5095
US

IV. Provider business mailing address

1201 W 250 N
ST GEORGE UT
84770-5095
US

V. Phone/Fax

Practice location:
  • Phone: 435-669-5358
  • Fax:
Mailing address:
  • Phone: 435-669-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number12062237-3400
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: