Healthcare Provider Details

I. General information

NPI: 1548187644
Provider Name (Legal Business Name): KIRA MITTELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 W TRIMBLE CREEK DR
WEST JORDAN UT
84088-9047
US

IV. Provider business mailing address

1058 W TRIMBLE CREEK DR
WEST JORDAN UT
84088-9047
US

V. Phone/Fax

Practice location:
  • Phone: 801-707-8461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-315702
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: