Healthcare Provider Details

I. General information

NPI: 1033998315
Provider Name (Legal Business Name): LISA M HILL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 10/10/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 S PIONEER PKWY STE 301
WEST VALLEY CITY UT
84120-2073
US

IV. Provider business mailing address

9645 S YORKSHIRE DR
SOUTH JORDAN UT
84009-9635
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-3865
  • Fax:
Mailing address:
  • Phone: 801-964-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number6755837-4402
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6755837-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: