Healthcare Provider Details

I. General information

NPI: 1356919955
Provider Name (Legal Business Name): AHINOAMAH FORBES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 10/22/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4769 W OLD CHURCH CT
WEST JORDAN UT
84084-7905
US

IV. Provider business mailing address

4769 W OLD CHURCH CT
WEST JORDAN UT
84084-7905
US

V. Phone/Fax

Practice location:
  • Phone: 801-916-5590
  • Fax:
Mailing address:
  • Phone: 801-916-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number5359208-4402
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5359208-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: